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Whitworth PW, Beitsch PD, Patel R, Rosen B, Compagnoni G, Baron PL, Simmons R, Brown EA, Gold L, Holmes D, Smith LA, Kinney M, Grady I, Clark P, Barbosa K, Lyons S, Riley L, Coomer C, Curcio L, Ruiz A, Khan S, MacDonald H, Hughes K, Hardwick MK, Heald B, Munro SB, Nielsen SM, Esplin ED. Clinical Utility of Universal Germline Genetic Testing for Patients With Breast Cancer. JAMA Netw Open 2022; 5:e2232787. [PMID: 36136330 PMCID: PMC9500554 DOI: 10.1001/jamanetworkopen.2022.32787] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE National Comprehensive Cancer Network guidelines currently recommend germline testing for high-risk genes in selected patients with breast cancer. The clinical utility of recommending testing all patients with breast cancer with multigene panels is currently under consideration. OBJECTIVE To examine the implications of universal testing of patients with breast cancer with respect to clinical decision-making. DESIGN, SETTING, AND PARTICIPANTS Patients from a previously reported cohort were assessed as in-criteria or out-of-criteria according to the 2017 guidelines and underwent testing with a multigene germline panel between 2017 to 2018. Patients were women and men aged 18 to 90 years, with a new and/or previous diagnosis of breast cancer who had not undergone either single or multigene testing. Clinicians from 20 community and academic sites documented patient clinical information and changes to clinical recommendations made according to test findings. Association between prevalence of pathogenic or likely pathogenic germline variants and previously unreported clinical features, including scores generated by the BRCAPRO statistical model, was determined. Data were analyzed from April 2020 to May 2022. EXPOSURE New and/or previous diagnosis of breast cancer. MAIN OUTCOMES AND MEASURES Disease management recommendations that were changed as a result of genetic testing results are reported. RESULTS Clinicians were asked to assess changes to clinical management as a result of germline genetic testing for 952 patients. Informative clinician-reported recommendations were provided for 939 (467 in-criteria and 472 out-of-criteria) of the patients with breast cancer (936 [99.7%] female; 702 [74.8%] White; mean [SD] age at initial diagnosis, 57.6 [11.5] years). One or more changes were reported for 31 of 37 (83.8%) in-criteria patients and 23 of 34 (67.6%) out-of-criteria patients with a pathogenic or likely pathogenic variant. Recommendations were changed as a result of testing results for 14 of 22 (63.6%) out-of-criteria patients who had a variant in a breast cancer predisposition gene. Clinicians considered testing beneficial for two-thirds of patients with pathogenic or likely pathogenic variants and for one-third of patients with either negative results or variants of uncertain significance. There was no difference in variant rate between patients meeting the BRCAPRO threshold (≥10%) and those who did not (P = .86, Fisher exact test). No changes to clinical recommendations were made for most patients with negative results (345 of 349 patients [98.9%]) or variants of uncertain significance (492 of 509 patients [96.7%]). CONCLUSIONS AND RELEVANCE In this cohort study, germline genetic testing was used by clinicians to direct treatment for most out-of-criteria patients with breast cancer with pathogenic or likely pathogenic germline variants, including those with moderate-risk variants. Universal germline testing informs clinical decision-making and provides access to targeted treatments and clinical trials for all patients with breast cancer.
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Affiliation(s)
- Pat W. Whitworth
- Nashville Breast Center, Nashville, Tennesee
- TME Breast Care Network, Dallas, Texas
| | - Peter D. Beitsch
- TME Breast Care Network, Dallas, Texas
- Invitae, San Francisco, California
| | - Rakesh Patel
- TME Breast Care Network, Dallas, Texas
- Invitae, San Francisco, California
| | | | | | | | - Rache Simmons
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Eric A. Brown
- Comprehensive Breast Care, A Division of Michigan Healthcare Professionals, Troy
| | - Linsey Gold
- Comprehensive Breast Care, A Division of Michigan Healthcare Professionals, Troy
| | | | | | - Michael Kinney
- Center for Advanced Breast Care, Arlington Heights, Illinois
| | - Ian Grady
- North Valley Breast Clinic, Redding, California
| | - Patricia Clark
- Ironwood Cancer and Research Centers, Scottsdale, Arizona
| | | | | | - Lee Riley
- St Luke’s University Health Network, Easton, Pennsylvania
| | - Cynara Coomer
- Department of Surgery, Northwell Staten Island University Hospital, Staten Island, New York
| | | | - Antonio Ruiz
- Chesapeake Regional Medical Center, Chesapeake, Virginia
| | - Sadia Khan
- Hoag Hospital Newport Beach, Newport Beach, California
| | | | - Kevin Hughes
- Department of Surgery, Medical University of South Carolina, Charleston
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2
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Whitworth PW, Beitsch PD, Murray MK, Richards PD, Mislowsky A, Dul CL, Pellicane JV, Baron PL, Rahman RL, Lee LA, Dupree BB, Kelemen PR, Ashikari AY, Budway RJ, Lopez-Penalver C, Dooley W, Wang S, Dauer P, Menicucci AR, Yoder EB, Finn C, Blumencranz LE, Audeh W. Genomic Classification of HER2-Positive Patients With 80-Gene and 70-Gene Signatures Identifies Diversity in Clinical Outcomes With HER2-Targeted Neoadjuvant Therapy. JCO Precis Oncol 2022; 6:e2200197. [PMID: 36108259 PMCID: PMC9489196 DOI: 10.1200/po.22.00197] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prospective Neoadjuvant Breast Registry Symphony Trial compared the 80-gene molecular subtyping signature with clinical assessment by immunohistochemistry and/or fluorescence in situ hybridization in predicting pathologic complete response (pCR) and 5-year outcomes in patients with early-stage breast cancer.
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Affiliation(s)
- Pat W Whitworth
- Nashville Breast Center, Nashville, TN.,Targeted Medical Education, Cupertino, CA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA.,Dallas Surgical Group, Dallas, TX
| | - Mary K Murray
- Akron General Medical Center, Akron, OH.,Cleveland Clinic Akron General, Akron, OH
| | | | - Angela Mislowsky
- Tidelands Health, Coastal Carolina Breast Center, Murrells Inlet, SC
| | - Carrie L Dul
- Ascension St John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC.,Lenox Hill Hospital, New York, NY
| | | | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA
| | - Beth B Dupree
- St Mary Medical/Alliance Cancer Specialists, Langhorne, PA.,Holy Redeemer Health System, Sedona, AZ
| | - Pond R Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY.,Northwell Health Physician Partners, Mount Kisco, NY
| | - Andrew Y Ashikari
- Ashikari Breast Center, Sleepy Hollow, NY.,Northwell Health Physician Partners, Mount Kisco, NY.,Zucker School of Medicine, Hofstra University, Hempstead, NY
| | | | | | - William Dooley
- Breast Institute, University of Oklahoma Health Sciences, Oklahoma City, OK.,Stephenson Cancer Center, Oklahoma City, OK
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Whitworth PW, Beitsch PD, Pellicane JV, Baron PL, Lee LA, Dul CL, Murray MK, Gittleman MA, Budway RJ, Rahman RL, Kelemen PR, Dooley WC, Rock DT, Cowan KH, Lesnikoski BA, Barone JL, Ashikari AY, Dupree BB, Wang S, Menicucci AR, Yoder EB, Finn C, Corcoran K, Blumencranz LE, Audeh W. Distinct Neoadjuvant Chemotherapy Response and 5-Year Outcome in Patients With Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Tumors That Reclassify as Basal-Type by the 80-Gene Signature. JCO Precis Oncol 2022; 6:e2100463. [PMID: 35476550 PMCID: PMC9200401 DOI: 10.1200/po.21.00463] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 12/13/2022] Open
Abstract
The 80-gene molecular subtyping signature (80-GS) reclassifies a proportion of immunohistochemistry (IHC)-defined luminal breast cancers (estrogen receptor–positive [ER+], human epidermal growth factor receptor 2–negative [HER2–]) as Basal-Type. We report the association of 80-GS reclassification with neoadjuvant treatment response and 5-year outcome in patients with breast cancer. Identity exposed: genomic assay unmasks TNBC-like breast cancer tumors disguised as HR+ #NBRST![]()
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Affiliation(s)
- Pat W Whitworth
- Nashville Breast Center, Nashville, TN.,Targeted Medical Education, Cupertino, CA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA.,Dallas Surgical Group, Dallas, TX
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC.,Lenox Hill Hospital/Northwell Health, New York, NY
| | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA
| | - Carrie L Dul
- Ascension St John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI
| | - Mary K Murray
- Akron General Medical Center, Akron, OH.,Cleveland Clinic Akron General, Akron, OH
| | | | | | | | - Pond R Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY.,Zucker School of Medicine, Hofstra University, Hempstead, NY
| | - William C Dooley
- Breast Institute, University of Oklahoma Health Sciences, Oklahoma City, OK.,Stephenson Cancer Center, Oklahoma City, OK
| | - David T Rock
- Regional Breast Care, Fort Myers, FL.,Genesis Care, Fort Myers, FL
| | - Kenneth H Cowan
- Fred and Pamela Buffet Cancer Center and Eppley Institute for Research in Cancer at University of Nebraska Medical Center, Omaha, NE
| | - Beth-Ann Lesnikoski
- The Breast Institute at JFK Medical Center, Atlantis, FL.,Baptist MD Anderson Cancer Center, Jacksonville, FL
| | - Julie L Barone
- Exempla Saint Joseph Hospital, Denver, CO.,Vail Health, Vail, CO
| | - Andrew Y Ashikari
- Zucker School of Medicine, Hofstra University, Hempstead, NY.,Northwell Health Physician Partners, Mount Kisco, NY
| | - Beth B Dupree
- St Mary Medical Alliance Cancer Specialists, Langhorne, PA
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Whitworth P, Beitsch PD, Pellicane JV, Baron PL, Lee LA, Dul CL, Nash CH, Murray MK, Richards PD, Gittleman M, Budway R, Layeequr Rahman R, Kelemen P, Dooley WC, Rock DT, Cowan KH, Lesnikoski BA, Barone JL, Ashikari AY, Dupree B, Wang S, Menicucci AR, Yoder EB, Finn C, Corcoran K, Blumencranz LE, Audeh W. ASO Visual Abstract: Age-Independent Preoperative Chemosensitivity and 5-Year Outcome Determined by Combined 70- and 80-Gene Signature in a Prospective Trial in Early-Stage Breast Cancer. Ann Surg Oncol 2022. [PMID: 35438465 DOI: 10.1245/s10434-022-11711-0] [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)
- Pat Whitworth
- Nashville Breast Center, Nashville, TN, USA.,Targeted Medical Education, Cupertino, CA, USA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA, USA.,Dallas Surgical Group, Dallas, TX, USA
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC, USA.,Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA, USA
| | - Carrie L Dul
- Ascension St. John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI, USA
| | | | - Mary K Murray
- Akron General Medical Center, Akron, OH, USA.,Cleveland Clinic Akron General, Akron, OH, USA
| | | | | | | | | | - Pond Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY, USA.,Zucker School of Medicine, Hofstra University, Hempstead, NY, USA
| | - William C Dooley
- BreastInstitute, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.,Stephenson Cancer Center, Oklahoma City, OK, USA
| | - David T Rock
- Regional Breast Care, Fort Myers, FL, USA.,Genesis Care, Fort Myers, FL, USA
| | - Ken H Cowan
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Beth-Ann Lesnikoski
- The Breast Institute at JFK Medical Center, Atlantis, FL, USA.,Baptist MD Anderson Cancer Center, Jacksonville, FL, USA
| | - Julie L Barone
- Exempla Saint Joseph Hospital, Denver, CO, USA.,Vail Health, Vail, CO, USA
| | - Andrew Y Ashikari
- Ashikari Breast Center, Sleepy Hollow, NY, USA.,New York Medical College, Valhalla, NY, USA.,Northwell Health Physician Partners, Mount Kisco, NY, USA.,Phelps and Northern Westchester Hospitals, Westchester, NY, USA
| | - Beth Dupree
- St. Mary Medical Alliance Cancer Specialists, Langhorne, PA, USA
| | - Shiyu Wang
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA
| | | | - Erin B Yoder
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA
| | | | - Kate Corcoran
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA
| | | | - William Audeh
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA.
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Whitworth P, Beitsch PD, Pellicane JV, Baron PL, Lee LA, Dul CL, Nash CH, Murray MK, Richards PD, Gittleman M, Budway R, Rahman RL, Kelemen P, Dooley WC, Rock DT, Cowan K, Lesnikoski BA, Barone JL, Ashikari AY, Dupree B, Wang S, Menicucci AR, Yoder EB, Finn C, Corcoran K, Blumencranz LE, Audeh W. Age-Independent Preoperative Chemosensitivity and 5-Year Outcome Determined by Combined 70- and 80-Gene Signature in a Prospective Trial in Early-Stage Breast Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11666-2. [PMID: 35378634 PMCID: PMC9174138 DOI: 10.1245/s10434-022-11666-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Neoadjuvant Breast Symphony Trial (NBRST) demonstrated the 70-gene risk of distant recurrence signature, MammaPrint, and the 80-gene molecular subtyping signature, BluePrint, precisely determined preoperative pathological complete response (pCR) in breast cancer patients. We report 5-year follow-up results in addition to an exploratory analysis by age and menopausal status. METHODS The observational, prospective NBRST (NCT01479101) included 954 early-stage breast cancer patients aged 18-90 years who received neoadjuvant chemotherapy and had clinical and genomic data available. Chemosensitivity and 5-year distant metastasis-free survival (DMFS) and overall survival (OS) were assessed. In a post hoc subanalysis, results were stratified by age (≤ 50 vs. > 50 years) and menopausal status in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) tumors. RESULTS MammaPrint and BluePrint further classified 23% of tumors to a different subtype compared with immunohistochemistry, with more precise correspondence to pCR rates. Five-year DMFS and OS were highest in MammaPrint Low Risk, Luminal A-type and HER2-type tumors, and lowest in MammaPrint High Risk, Luminal B-type and Basal-type tumors. There was no significant difference in chemosensitivity between younger and older patients with Low-Risk (2.2% vs. 3.8%; p = 0.64) or High-Risk tumors (14.5% vs. 11.5%; p = 0.42), or within each BluePrint subtype; this was similar when stratifying by menopausal status. The 5-year outcomes were comparable by age or menopausal status for each molecular subtype. CONCLUSION Intrinsic preoperative chemosensitivity and long-term outcomes were precisely determined by BluePrint and MammaPrint regardless of patient age, supporting the utility of these assays to inform treatment and surgical decisions in early-stage breast cancer.
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Affiliation(s)
- Pat Whitworth
- Nashville Breast Center, Nashville, TN, USA
- Targeted Medical Education, Cupertino, CA, USA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA, USA
- Dallas Surgical Group, Dallas, TX, USA
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC, USA
- Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA, USA
| | - Carrie L Dul
- Ascension St. John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI, USA
| | | | - Mary K Murray
- Akron General Medical Center, Akron, OH, USA
- Cleveland Clinic Akron General, Akron, OH, USA
| | | | | | | | | | - Pond Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY, USA
- Zucker School of Medicine, Hofstra University, Hempstead, NY, USA
| | - William C Dooley
- Breast Institute, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - David T Rock
- Regional Breast Care, Fort Myers, FL, USA
- Genesis Care, Fort Myers, FL, USA
| | - Ken Cowan
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Beth-Ann Lesnikoski
- The Breast Institute at JFK Medical Center, Atlantis, FL, USA
- Baptist MD Anderson Cancer Center, Jacksonville, FL, USA
| | - Julie L Barone
- Exempla Saint Joseph Hospital, Denver, CO, USA
- Vail Health, Vail, CO, USA
| | - Andrew Y Ashikari
- Ashikari Breast Center, Sleepy Hollow, NY, USA
- New York Medical College, Valhalla, NY, USA
- Northwell Health Physician Partners, Mount Kisco, NY, USA
- Phelps and Northern Westchester Hospitals, Westchester, NY, USA
| | - Beth Dupree
- St. Mary Medical Alliance Cancer Specialists, Langhorne, PA, USA
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Baron PL, Margenthaler JA, Dietz JR. Assessment of Screening Mammography Recommendations. JAMA Intern Med 2021; 181:1261-1262. [PMID: 34228049 DOI: 10.1001/jamainternmed.2021.3532] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul L Baron
- Department of Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jill R Dietz
- Allegheny Health Network, Pittsburgh, Pennsylvania
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7
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Lanfranconi S, Locatelli F, Corti S, Candelise L, Comi GP, Baron PL, Strazzer S, Bresolin N, Bersano A. Growth factors in ischemic stroke. J Cell Mol Med 2011; 15:1645-87. [PMID: 20015202 PMCID: PMC4373358 DOI: 10.1111/j.1582-4934.2009.00987.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 11/26/2009] [Indexed: 12/31/2022] Open
Abstract
Data from pre-clinical and clinical studies provide evidence that colony-stimulating factors (CSFs) and other growth factors (GFs) can improve stroke outcome by reducing stroke damage through their anti-apoptotic and anti-inflammatory effects, and by promoting angiogenesis and neurogenesis. This review provides a critical and up-to-date literature review on CSF use in stroke. We searched for experimental and clinical studies on haemopoietic GFs such as granulocyte CSF, erythropoietin, granulocyte-macrophage colony-stimulating factor, stem cell factor (SCF), vascular endothelial GF, stromal cell-derived factor-1α and SCF in ischemic stroke. We also considered studies on insulin-like growth factor-1 and neurotrophins. Despite promising results from animal models, the lack of data in human beings hampers efficacy assessments of GFs on stroke outcome. We provide a comprehensive and critical view of the present knowledge about GFs and stroke, and an overview of ongoing and future prospects.
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Affiliation(s)
- S Lanfranconi
- Dipartimento di Scienze Neurologiche, Dino Ferrari Centre, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di MilanoMilan, Italy
| | - F Locatelli
- Istituto E. Medea, Fondazione La Nostra FamigliaBosisio Parini, Lecco, Italy
| | - S Corti
- Dipartimento di Scienze Neurologiche, Dino Ferrari Centre, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di MilanoMilan, Italy
| | - L Candelise
- Dipartimento di Scienze Neurologiche, Dino Ferrari Centre, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di MilanoMilan, Italy
| | - G P Comi
- Dipartimento di Scienze Neurologiche, Dino Ferrari Centre, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di MilanoMilan, Italy
| | - P L Baron
- Dipartimento di Scienze Neurologiche, Dino Ferrari Centre, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di MilanoMilan, Italy
| | - S Strazzer
- Istituto E. Medea, Fondazione La Nostra FamigliaBosisio Parini, Lecco, Italy
| | - N Bresolin
- Dipartimento di Scienze Neurologiche, Dino Ferrari Centre, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di MilanoMilan, Italy
- Istituto E. Medea, Fondazione La Nostra FamigliaBosisio Parini, Lecco, Italy
| | - A Bersano
- Dipartimento di Scienze Neurologiche, Dino Ferrari Centre, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di MilanoMilan, Italy
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8
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Conti G, Baron PL, Scarpini E, Bresolin E, De Pol A. Pro-inflammatory cytokines induce differentiation in cultured schwann cells. J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209g.x] [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: 11/28/2022]
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9
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Conti G, Rostami A, Scarpini E, Baron PL, Galimberti D, Scarlato G, Palumbo C, De Pol A. Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 13. J Peripher Nerv Syst 2003. [DOI: 10.1046/j.1529-8027.2003.00013.x] [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: 11/20/2022]
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10
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Conti G, Scarpini E, De Pol A, Bava L, Vaccina F, Bussini S, Baron PL, Scarlato G. IL‐1β and Interferon‐γ Induce Schwann Cell Proliferation And Death. J Peripher Nerv Syst 2001. [DOI: 10.1046/j.1529-8027.2001.01007-15.x] [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: 11/20/2022]
Affiliation(s)
- G Conti
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
| | - E Scarpini
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
| | - A De Pol
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
| | - L Bava
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
| | - F Vaccina
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
| | - S Bussini
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
| | - PL Baron
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
| | - G. Scarlato
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore, Milan
- Dept. of Morphological Sciences, University of Modena, Italy
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Baron PL, Bianchi R, Livraghi S, Bussini S, Bava L, Scarpini E, Conti G, Scarlato G, Tacconi MT, Oggioni N, Petruccioli M, Cavaletti G, Tredici G. Experimental Lead Neuropathy: Ultrastructural And Molecular Changes In The Rat Sciatic Nerve. J Peripher Nerv Syst 2001. [DOI: 10.1046/j.1529-8027.2001.01007-2.x] [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: 11/20/2022]
Affiliation(s)
- PL Baron
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - R Bianchi
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - S Livraghi
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - S Bussini
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - L Bava
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - E Scarpini
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - G Conti
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - G Scarlato
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - MT Tacconi
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - N Oggioni
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - Mg Petruccioli
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - G Cavaletti
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
| | - G. Tredici
- Clin Neurol, Univ Milano, IRCCS Osp Maggiore, Milano
- Ist Ric Farmacol “M. Negri”, Milano
- Novuspharma S.p.A., Monza (MI)
- Ist Anat Umana, Univ Milano
- Clin Neurol, A.O. S. Gerardo, Monza (MI)
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Mitas M, Mikhitarian K, Walters C, Baron PL, Elliott BM, Brothers TE, Robison JG, Metcalf JS, Palesch YY, Zhang Z, Gillanders WE, Cole DJ. Quantitative real-time RT-PCR detection of breast cancer micrometastasis using a multigene marker panel. Int J Cancer 2001; 93:162-71. [PMID: 11410861 DOI: 10.1002/ijc.1312] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [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: 11/09/2022]
Abstract
Real-time RT-PCR is a relatively new technology that uses an online fluorescence detection system to determine gene expression levels. It has the potential to significantly improve detection of breast cancer metastasis by virtue of its exquisite sensitivity, high throughput capacity and quantitative readout system. To assess the utility of this technology in breast cancer staging, we determined the relative expression levels of 12 cancer-associated genes (mam, PIP, mamB, CEA, CK19, VEGF, erbB2, muc1, c-myc, p97, vim and Ki67) in 51 negative-control normal lymph nodes and in 17 histopathology-positive ALNs. We then performed a receiver operating characteristic (ROC) curve analysis to determine the sensitivity and specificity levels of each gene. Areas under the ROC curve indicated that the most accurate diagnostic markers were mam (99.6%), PIP (93.3%), CK19 (91.0%), mamB (87.9%), muc1 (81.5%) and CEA (79.4.0%). mam was overexpressed in 16 of 17 lymph nodes known to contain metastatic breast cancer at levels ranging from 22- to 2.8 x 10(5)-fold above normal mean expression, whereas PIP was overexpressed from 30- to 2.2 x 10(6)-fold above normal in 13 lymph nodes. Real-time RT-PCR analysis of pathology-negative LN from breast cancer patients revealed evidence of overexpression of PIP (6 nodes), mam (3 nodes) and CEA (1 node) in 8 of 21 nodes (38%). Our results provide evidence that mam, PIP, CK19, mamB, muc1 and CEA can be applied as a panel for detection of metastatic and occult micrometastatic disease.
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Affiliation(s)
- M Mitas
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
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13
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Clerici R, Conti G, Scarpini E, De Riz M, Baron PL, Scarlato G. Visual loss and enlarged extraocular muscles from metastatic signet ring carcinoma. J Neurol 2001; 248:336-8. [PMID: 11374103 DOI: 10.1007/s004150170213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Newton DA, Acierno PM, Metts MC, Baron PL, Brescia FJ, Gattoni-Celli S. Semiallogeneic cancer vaccines formulated with granulocyte-macrophage colony-stimulating factor for patients with metastatic gastrointestinal adenocarcinomas: a pilot phase I study. J Immunother 2001; 24:19-26. [PMID: 11211145 DOI: 10.1097/00002371-200101000-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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
The authors report the results of a phase I clinical study using semiallogeneic cancer vaccines formulated with granulocyte-macrophage colony-stimulating factor (GM-CSF) to treat patients with metastatic adenocarcinomas of the gastrointestinal tract. A specially engineered cell line, FO1-12, was used to generate semiallogeneic hybrids by fusion with patient-derived tumor cells; the hybrids express HLA class I and II haplotypes derived from both parental cells. For treatment, the vaccine was mixed with GM-CSF, irradiated, and injected intradermally into patients at weekly or biweekly intervals. Vaccinations were associated with minimal or no toxicity and showed that semiallogeneic hybrids formulated with GM-CSF can induce a specific antitumor immune response in some patients, as measured by a delayed-type hypersensitivity response to autologous tumor cells. Because of the simplicity, feasibility, and flexibility of this immunotherapeutic approach, semiallogeneic hybrid vaccines have the potential to be used in the treatment of virtually any type of cancer.
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Affiliation(s)
- D A Newton
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
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15
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Nguyen CL, McClay EF, Cole DJ, O'Brien PH, Gillanders WE, Metcalf JS, Maize JC, Baron PL. Melanoma thickness and histology predict sentinel lymph node status. Am J Surg 2001; 181:8-11. [PMID: 11248167 DOI: 10.1016/s0002-9610(00)00533-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [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: 10/18/2022]
Abstract
BACKGROUND It remains unclear which patients with melanoma will benefit most from lymphatic mapping and sentinel lymphadenectomy. The purpose of this study is to determine whether primary melanoma histopathologic features could be applied to predict sentinel node status. METHODS One hundred twelve patients underwent sentinel node biopsy between May 1995 and August 1999. Reported histologic features were assessed for predictive value by univariate and multivariate logistic regression. RESULTS The sentinel node was located successfully in 105 of the 112 patients (94%). Twenty-one of these 105 patients (20%) had sentinel nodes that were positive for metastatic disease. Multivariate analyses revealed that tumor thickness greater than 1.5 mm (P = 0.01), ulceration (P <0.01), and lymphovascular invasion (P = 0.05) predicted the presence of micrometastases. CONCLUSIONS The presence of unfavorable histopathology such as ulceration and lymphovascular invasion may identify a group of patients with thin melanomas who would benefit from sentinel lymphadenectomy.
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Affiliation(s)
- C L Nguyen
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, P.O. Box 250613, 29425, Charleston, SC, USA
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16
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Kelley JR, Brown JM, Frasier MM, Baron PL, Schweinfest CW, Vournakis JN, Watson DK, Cole DJ. The cancer-associated Sm-like oncogene: a novel target for the gene therapy of pancreatic cancer. Surgery 2000; 128:353-60. [PMID: 10923016 DOI: 10.1067/msy.2000.107605] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 11/22/2022]
Abstract
BACKGROUND The prognosis for pancreatic cancer (PC) remains dismal, providing a clear need for the development of novel therapies. We have previously shown that the cancer-associated Sm-like (CaSm) oncogene is overexpressed in the great majority of pancreatic tumors and is required to maintain the transformed phenotype. The purpose of this study was to determine whether the application of CaSm antisense gene therapy would generate a significant antitumor effect against PC. METHODS An adenoviral vector (Ad-alphaCaSm) expressing a 900-base pair antisense RNA to CaSm was created. The PC cell lines AsPC-1 and Capan-1 were infected with this vector and examined for changes in in vitro proliferation by using methyl thiazol tetrazolium and soft agar assays. SCID-Bg mice bearing subcutaneous AsPC-1 tumors were treated with Ad-alphaCaSm (1 x 10(9) plaque-forming units) as a single intratumor injection with tumor growth and survival monitored. RESULTS AsPC-1 and Capan-1 cells showed decreased in vitro proliferation (93%, P =.0041, and 70%, P =. 0038, respectively) and anchorage independent growth (55%, P =.02, and 45%, P =.03, respectively) after treatment. Ad-alphaCaSm reduced in vivo AsPC-1 tumor growth by 40% (n = 10), extending median survival time from 35 to 60 days. CONCLUSIONS Ad-alphaCaSm demonstrates a significant antitumor effect against pancreatic cancer both in vitro and in vivo. These results support the role of CaSm as a significant gene involved in the neoplastic transformation of pancreatic tumors. Thus CaSm represents a novel gene target in PC and holds potential as a new treatment approach either alone or in combination with existing therapies.
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Affiliation(s)
- J R Kelley
- Department of Surgery, Center for Molecular and Structural Biology, and Hollings Cancer Center, Medical University of South Carolina, Charleston 29425, USA
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17
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McClay EF, McClay ME, Monroe L, Baron PL, Cole DJ, O'Brien PH, Metcalf JS, Maize JC. The effect of tamoxifen and cisplatin on the disease-free and overall survival of patients with high risk malignant melanoma. Br J Cancer 2000; 83:16-21. [PMID: 10883662 PMCID: PMC2374536 DOI: 10.1054/bjoc.1999.1220] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The adjuvant treatment of high-risk malignant melanoma remains problematic. Previously we reported moderate success in the treatment of metastatic disease using tamoxifen, cisplatin, dacarbazine and carmustine. Based upon data that suggested tamoxifen and cisplatin were the active agents in this regimen, we initiated a phase II trial of this combination in the adjuvant setting. We treated 153 patients with 4 cycles of tamoxifen (160 mg day(-1), days 1-7) and cisplatin (100 mg m(-2), day 2) for 28-day intervals. Patients received an anti-nausea regimen of dexamethasone with ondansetron or granisetron. During the first 2 years of follow-up, patients were evaluated every 2 months with a history, physical exam, laboratory work and computed tomography scans of the chest, abdomen and pelvis every 4 months. Thereafter, patients were evaluated every 3 months and radiographic studies were performed if necessary. Currently, with a median follow-up of 36 months, the disease-free survival (DFS) is 68.4% and overall survival (OS) is 84.5%. Kaplan-Meier analysis predicts a 5-year DFS of 62% with an OS of 79%. Relapses after 20 months have been rare. No effect of gender or number of positive lymph nodes was noted, however, stage of disease prior treatment was a factor. The major toxicity proved to be gastrointestinal in nature with nausea the most prevalent symptom. Minimal renal, haematologic and neurologic toxicity occurred. These preliminary results suggest that there is a positive impact of tamoxifen and cisplatin on both the DFS and OS of high-risk malignant melanoma patients. The 5-year projected DFS and OS compare favourably with those reported for the ECOG 1684 trial and warrant confirmation in a prospective randomized trial.
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Affiliation(s)
- E F McClay
- Department of Medicine, University of California, San Diego, La Jolla 92093-0063, USA
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18
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Baron LF, Baron PL, Ackerman SJ, Durden DD, Pope TL. Sonographically guided clip placement facilitates localization of breast cancer after neoadjuvant chemotherapy. AJR Am J Roentgenol 2000; 174:539-40. [PMID: 10658738 DOI: 10.2214/ajr.174.2.1740539] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- L F Baron
- Department of Radiology, Hollings Cancer Center, Medical University of South Carolina, Charleston 29425, USA
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Cole DJ, Baron PL, O'Brien P, Reed CE, Schlom J, Tsang KY. Phase I Study of Recombinant Carcinoembryonic Antigen (CEA) Vaccinia Virus Vaccine With Post Vaccination Carcinoembryonic Antigen Peptide (CAP-1) Boost. Clin Lung Cancer 2000; 1:227-9. [PMID: 14733650 DOI: 10.3816/clc.2000.n.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D J Cole
- MUSC Department of Surgery and Hollings Cancer Center, Charleston, South Carolina 29425, USA.
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20
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Scarpini E, Conti GC, Bussini S, Clerici R, Siglienti I, Piccio L, De Pol A, Baron PL, Scarlato G. Human schwann cell proliferation and IL-6 production following TNF-alpha stimulation in vitro. Ann N Y Acad Sci 1999; 883:520-2. [PMID: 10586289] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- E Scarpini
- Department of Neurology, Dino Ferrrari Center, IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy
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21
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Conti G, Scarpini E, Rostami A, Livraghi S, Clerici R, Piccio L, Siglienti I, Baron PL, Pleasure D, Scarlato G. Schwann cell apoptosis during cell-mediated demyelination. Ann N Y Acad Sci 1999; 883:518-9. [PMID: 10586288] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- G Conti
- Department of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore Policlinico, Italy
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22
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Cole DJ, Connolly RJ, Chan MW, Schwaitzberg SD, Byrne T, Adams DB, Baron PL, O'Brien PH, Metcalf JS, Demcheva M, Vournakis J. A pilot study evaluating the efficacy of a fully acetylated poly-N-acetyl glucosamine membrane formulation as a topical hemostatic agent. Surgery 1999. [DOI: 10.1016/s0039-6060(99)70092-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Cole DJ, Connolly RJ, Chan MW, Schwaitzberg SD, Byrne TK, Adams DB, Baron PL, O'Brien PH, Metcalf JS, Demcheva M, Vournakis J. A pilot study evaluating the efficacy of a fully acetylated poly-N-acetyl glucosamine membrane formulation as a topical hemostatic agent. Surgery 1999; 126:510-7. [PMID: 10486603] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Topical hemostatic agents are frequently needed for control of intraoperative bleeding. Currently available topical products each have potential drawbacks, making a more effective topical hemostatic agent desirable. This study was performed to evaluate the effectiveness of a particular formulation of a newly available polysaccharide polymer, poly-N-acetyl glucosamine (p-GlcNAc), as a topical hemostatic agent for use in the operating room. Swine splenic incision and splenic capsular stripping hemorrhage models were initially used, with a subsequent pilot human study then performed. METHODS For the swine splenic incision model, anesthetized immature female Yorkshire white swine had a 3 x 8 mm incision created on the spleen. One of 3 agents (p-GlcNAc membrane, oxidized cellulose, or absorbable collagen) was sequentially applied to individual wounds and digitally compressed for 20 seconds. The wound was observed without pressure for 2 minutes. Up to 8 wounds per animal were created in 7 animals. For the swine splenic capsular stripping model a 2 x 2 cm area of capsular stripping on the surface of the spleen to a depth of 3 mm was created. Either p-GlcNAc membrane or oxidized cellulose was applied and digitally compressed for 60 seconds, followed by observation without pressure for 2 minutes. Six wounds per animal were created in 2 animals. If bleeding persisted in either model, a new cycle of compression was applied. These steps were repeated until hemostasis was achieved. No change in hemodynamics or coagulation factors was observed in either model. Subsequently, 10 consecutive patients undergoing elective small-bowel surgery were enrolled on pilot study. A 5 x 3 x 3 mm cruciate incision was created midway between the mesenteric and antimesenteric borders of the small bowel. Either p-GlcNAc membrane formulation or oxidized cellulose was applied (the sequence alternated per patient) with a 400-mg weight used for even, direct pressure. A second cruciate incision was then created on the contralateral side of the bowel to evaluate the second material. The number of applications required for hemostasis was assessed. Hemodynamics, small-bowel pathologic condition, and hematologic parameters were evaluated. RESULTS The p-GlcNAc membrane required fewer cycles of compression in the swine splenic incision model to achieve hemostasis than either absorbable collagen or oxidized cellulose (1.25 vs 2.58 and 3.41, respectively; P < .01) and caused more effective immediate cessation of bleeding (79% for p-GlcNAc vs 17% for both absorbable collagen and oxidized cellulose). With the more traumatic splenic capsular stripping model, p-GlcNAc required fewer cycles of compression to achieve hemostasis than oxidized cellulose (average, 2.5 versus 6.8 respectively; P < .01) and was able to achieve hemostasis with greater efficacy (50%) in 2 applications than did oxidized cellulose (0%; P < .01). When used in the human pilot study, p-GlcNAc membranes required fewer cycles of compression than oxidized cellulose (2.5 vs 5.4, respectively; P < .002), was able to stop bleeding with greater efficacy in 1 cycle of compression (50% vs 0%, respectively; P < .01), and ultimately accomplished hemostasis in 80% of the cases as opposed to 20%. CONCLUSIONS On the basis of its greater hemostatic efficacy as compared with collagen or oxidized cellulose-based products, p-GlcNAc holds promise as an effective topical hemostatic agent and deserves further evaluation.
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Affiliation(s)
- D J Cole
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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24
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Baron PL, Kay C, Hoffman B. Pancreatic imaging. Surg Oncol Clin N Am 1999; 8:35-58. [PMID: 9824361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Pancreatic cancer has traditionally been difficult to diagnose. There are now numerous diagnostic tests that can visualize these tumors early when they are small and determine which cases are the most likely to be unresectable. The principal tests, including spiral CT, MR imaging, endoscopic ultrasound, and laparoscopy, have advantages and disadvantages. The purpose of this article is to review each technique, and try to come up with a recommended approach to evaluating the patient with pancreatic malignancy.
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Affiliation(s)
- P L Baron
- Section of Surgical Oncology, Department of Surgery, and the Digestive Disease Center, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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25
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Abstract
BACKGROUND Recent advances in molecular oncology have provided explanations at the DNA level for the malignant transformation and metastatic potential of various cancers. Malignant melanoma and pancreatic cancer may be classified together in both these cancers exhibit mutations in, or loss of, the cell-cycle inhibitory gene, p16. This paper reviews the current literature on p16 expression in melanoma and pancreatic cancer, explores factors that place patients with these cancers in categories of high risk for metastases or recurrence, and addresses whether aberrant gene expressions should influence awareness of and current recommendations for the management of these aggressive cancers. METHODS A computerized literature search was performed utilizing OVID Technology's Medline database from 1993 to 1998. RESULTS Both familial as well as sporadic cases of malignant melanoma and pancreatic carcinoma are reported in the literature. Although a low percentage of cases of either malignancy have p16 mutations, a higher risk of their development has been reported to occur in certain families with p16 germline mutations. CONCLUSIONS The increased risk determined in these families may serve to heighten awareness of the influence of positive family history of these cancers in the evaluation of patients.
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Affiliation(s)
- G J Bullock
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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27
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Conti G, Scarpini E, Rostami A, Livraghi S, Baron PL, Pleasure D, Scarlato G. Schwann cell undergoes apoptosis during experimental allergic neuritis (EAN). J Neurol Sci 1998; 161:29-35. [PMID: 9879678 DOI: 10.1016/s0022-510x(98)00260-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Schwann cell apoptosis is not detectable in the normal mature mammalian peripheral nervous system (PNS). However, during PNS cell-mediated demyelination, apoptosis contributes to the elimination of endoneurial T-lymphocytes. We report here that approximately 10% of Schwann cells die by apoptosis during the early phases of recovery from experimental autoimmune neuritis (EAN) in the adult rat, a model for the Guillain-Barrè syndrome. Schwann cell apoptosis, follows endoneurial T-cell clearance, and is prominent in the nerve roots, the site of most severe segmental demyelination, but is rare in the more distal regions of the PNS, where Wallerian degeneration predominates. Further immunological analysis showed that the p75 neurotrophin receptor (p75NTR) is expressed in 2% of both apoptotic and non apoptotic Schwann cells, while Ki-67, a marker of cell proliferation, is expressed in 20% of apoptotic and in 1% of non apoptotic Schwann cells. Our new observations indicate that apoptosis during cell-mediated demyelination can be a phenomenon related either to the development or the recovery of autoimmune cell mediated inflammation.
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Affiliation(s)
- G Conti
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore Policlinico, Italy
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28
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Lockett MA, Baron PL, O'Brien PH, Elliott BM, Robison JG, Maitre N, Metcalf JS, Cole DJ. Detection of occult breast cancer micrometastases in axillary lymph nodes using a multimarker reverse transcriptase-polymerase chain reaction panel. J Am Coll Surg 1998; 187:9-16. [PMID: 9660019 DOI: 10.1016/s1072-7515(98)00130-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [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: 02/08/2023]
Abstract
BACKGROUND Axillary lymph node status in breast cancer patients remains the single most important predictor of outcomes. Current methods of histopathologic analysis may be inadequate because 30% of node-negative patients recur. The purpose of this study was to test the hypothesis that a multigene reverse transcriptase-polymerase chain reaction (RT-PCR) panel provides a more sensitive method to detect axillary lymph node metastases than routine pathologic examination. STUDY DESIGN Sixty-one consecutive breast cancer patients were evaluated, with nine normal control patients. Nodes > 1 cm were bisected for histopathologic and RT-PCR analysis. Nodal tissue was homogenized, and total RNA was converted into cDNA with reverse transcriptase. Reverse transcriptase-polymerase chain reaction analysis was performed with primers specific for keratin-19, c-myc, prolactin inducible protein (PIP), and beta-actin using ethidium bromide gel electrophoresis. Reverse transcriptase-polymerase chain reaction positive/ pathology negative axillary lymph nodes were reevaluated using step sectioning and immunohistochemical staining. RESULTS Thirty-seven patients had pathologically negative axillary lymph nodes, of which 15 (40%) were positive by RT-PCR analysis. Two RT-PCR negative results (one probably from tissue processing error and the other secondary to sampling error) among the 24 histologically positive specimens were detected (8%). The number of patients in each pathologic stage was 26 patients in stage I; 18, stage IIA; 7, stage IIB; 7, stage IIIA; 3, stage IIIB; and 0 patients in stage IV. By RT-PCR staging, 8 of 26 patients went from stage I to IIA (30%), and 7 of 18 from stage IIA to IIB (39%). Of the RT-PCR positive individuals who were stage I by pathologic analysis, 100% were found to be c-myc positive, 0% keratin-19 positive, and 0% PIP positive; for stage IIIB patients these markers were 50%, 100%, and 100% respectively. Additionally, an increasing number of positive markers per specimen appeared to correlate with larger primary tumor size (p < 0.01) and decreased predicted 5-year survival (r = 0.950, p < 0.002). CONCLUSIONS Multimarker RT-PCR analysis appears to be a readily available and highly sensitive method for the detection of axillary lymph node micrometastases. Longterm followup of RT-PCR positive patients will be required to determine its clinical relevance. If validated as a predictor of disease recurrence, this method would provide a powerful complement to routine histopathologic analysis of axillary lymph nodes.
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Affiliation(s)
- M A Lockett
- Department of Surgery, Hollings Cancer Center and Medical University of South Carolina, Charleston 29425, USA
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Lockett MA, Metcalf JS, Baron PL, O'Brien PH, Elliott BM, Robison JG, Cole DJ. Efficacy of reverse transcriptase-polymerase chain reaction screening for micrometastic disease in axillary lymph nodes of breast cancer patients. Am Surg 1998; 64:539-43; discussion 543-4. [PMID: 9619175] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pathologic examination of axillary lymph nodes (ALNs) may miss micrometastases in 30 per cent of breast cancer patients. We have developed a multimarker reverse transcriptase-polymerase chain reaction (RT-PCR)-based screening method that detects histopathologically positive ALNs with a 5 per cent false-negative rate. The purpose of this study was to compare this RT-PCR methodology with histopathology with regard to sensitivity and cost. Pathologically negative ALNs from 35 breast cancer patients were re-evaluated by a single pathologist in a blinded fashion using serial sectioning with immunohistochemical staining. Histopathologic results were then compared with those of RT-PCR. Cost analysis was performed based on standard charges for these methods. RT-PCR identified micrometastases in 14 of 35 pathologically negative nodes. Serial sectioning and immunohistochemical staining identified micrometastases in two cases, with RT-PCR positive for one of these. The charge per specimen for performing routine histopathologic examination was $380, serial sectioning and immunohistochemical staining $787, and RT-PCR $125. RT-PCR appears to be more sensitive at detecting ALN micrometastasis than histopathologic examination even with serial sectioning and immunohistochemical staining. If micrometastatic breast cancer detected by RT-PCR proves to be clinically relevant, it could be a more effective screening methodology with significant cost savings as compared to currently available pathologic examinations.
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Affiliation(s)
- M A Lockett
- Department of Surgery (Section of Surgical Oncology), Hollings Cancer Center, Medical University of South Carolina, Charleston 29425, USA
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Baron PL. Current trends in the management of melanoma. J S C Med Assoc 1998; 94:274-277. [PMID: 9648410] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- P L Baron
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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Schweinfest CW, Graber MW, Henderson KW, Papas TS, Baron PL, Watson DK. Cloning and sequence analysis of Hsp89alpha DeltaN, a new member of theHsp90 gene family. Biochim Biophys Acta 1998; 1398:18-24. [PMID: 9602032 DOI: 10.1016/s0167-4781(98)00031-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We have identified a novel member of the Hsp90 gene family. This new gene, Hsp89alpha DeltaN, is remarkable in that it appears to represent a recent evolutionary event. Hsp89alpha DeltaN is identical in nucleotide sequence to Hsp89alpha for codons 224 to 732 (end). However, Hsp89alpha DeltaN cDNA lacks the ATP/geldanamycin binding domain (codons 1-220), instead containing 544 nucleotides of unique DNA at its 5' end including 30 novel codons.
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Affiliation(s)
- C W Schweinfest
- Center for Molecular and Structural Biology, Hollings Cancer Center, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425, USA
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Kulling D, Feldman DR, Kay CL, Bohning DE, Hoffman BJ, Van Velse AK, Baron PL, Lahr CJ, Hawes RH. Local staging of anal and distal colorectal tumors with the magnetic resonance endoscope. Gastrointest Endosc 1998; 47:172-8. [PMID: 9512284 DOI: 10.1016/s0016-5107(98)70352-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND We prospectively assessed the feasibility and accuracy of endoscopic magnetic resonance (EMR) scanning in the local staging of anal and colorectal cancer as compared to endosonography. METHODS Fifteen patients with biopsy-proven anal (n = 2), rectal (n = 11), and distal colonic (n = 2) cancer underwent endosonography followed by EMR imaging. Scans were acquired using the magnetic resonance receiver coil incorporated into the tip of the non-ferromagnetic endoscope. Blinded to endosonography results, two radiologists interpreted the EMR images using the TNM system. Staging results were compared to endosonography in all patients and to histopathology in the 13 colorectal cases. RESULTS EMR imaging, well tolerated in all patients, correlated with endosonography in 10 of 15 and 12 of 15 cases for T- and N-staging, respectively. In the 13 colorectal patients with available histopathology, accuracy of EMR and of endosonography in T-staging was 77% and 85%, respectively; N-staging accuracy was 62% for both. CONCLUSIONS For anal and distal colorectal neoplasms, EMR imaging is feasible and provides local staging comparable to endosonography.
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Affiliation(s)
- D Kulling
- Department of Medicine, Medical University of South Carolina, Charleston 29425, USA
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Feldman DR, Kulling DP, Kay CL, Cole DJ, Cunningham JT, Hawes RH, Tarnasky PR, Cotton PB, Baron PL. Magnetic resonance cholangiopancreatography: a novel approach to the evaluation of suspected pancreaticobiliary neoplasms. Ann Surg Oncol 1997; 4:634-8. [PMID: 9416410 DOI: 10.1007/bf02303747] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [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: 02/05/2023]
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is a new noninvasive diagnostic method for pancreaticobiliary (PB) imaging without endoscopy, sedation, or iodinated contrast. The purpose of this study was to evaluate the ability of MRCP to depict pancreatic and biliary ductal anatomy compared to that of endoscopic retrograde cholangiopancreatography (ERCP) and to evaluate the ability of MRCP to accurately diagnose PB neoplasms. METHODS Twenty patients had MRCP, and 17 also had ERCP. All studies were read prospectively by experienced reviewers blinded to other imaging data. Pathologic diagnosis was made in all patients. RESULTS Bile duct dilatation seen by ERCP in 14 of 17 patients was correctly identified by MRCP in all 14 patients, and normal ducts were correctly identified by MRCP in the other 3 patients. The pancreatic duct was visible on MRCP in the pancreatic head in 17 of 20 patients, the body in 17 of 20 patients, and the tail in 15 of 20 patients. At ERCP, pancreatic duct dilatation was present in 11 cases and was identified by MRCP in 10 of them. Eighteen of 20 patients had malignant PB neoplasms. MRCP indicated PB neoplasm in 19 patients. Seventeen of these 19 patients had histologically confirmed malignant neoplasms pathologically, whereas 2 had benign pathology (both chronic pancreatitis). Among the 17 patients who also had ERCP, MRCP and ERCP correctly agreed on a final diagnosis of malignant neoplasm in 14 cases. In the three cases in which MRCP and ERCP disagreed on a final diagnosis, MRCP was correct in one and incorrect in two. CONCLUSIONS MRCP can accurately and noninvasively delineate PB ductal anatomy and diagnose PB neoplasms comparably to ERCP. MRCP is an interesting new noninvasive method for evaluating patients with suspected PB neoplasms.
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Affiliation(s)
- D R Feldman
- Department of Diagnostic Radiology, Medical University of South Carolina, Charleston 29425, USA
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Pitre B, Baron PL, Baron LF, O'Brien PH, Cole DJ. Stereotactic core biopsy of the breast: results of one-year follow-up of 101 patients. Am Surg 1997; 63:1124-7. [PMID: 9393264] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stereotactic core biopsy (SCB) is being used as a cost-effective alternative to needle localized biopsy (NLB). However, an area of concern is the potential for sampling error, with sparse surgical data available concerning follow-up and failure rates. We therefore reviewed our results in patients undergoing SCB for mammographically detected breast abnormalities. Between January 1994 and February 1995, 128 patients underwent SCB. Average age was 56.4 years. Nine patients (7.0%) had histologic evidence of malignancy, with 111 (86.7%) benign diagnoses requiring no further initial intervention. Eight patients (6.3%) proceeded directly to NLB, five because of technical failure of SCB and three because of suspicious initial histology. One of the latter patients had ductal carcinoma in situ. The remaining 111 SCB patients were evaluated at 6 months and 1 year by mammographic and physical examination. Ten patients were lost to follow-up. Of the remaining 101 patients, 98 (97%) had stable mammograms and normal physical examinations. Three patients (3.9%) required subsequent NLB due to progression of the mammographic lesion. Two cases were histologically benign, and 1 patient had ductal carcinoma in situ adjacent to the previous SCB biopsy site. An additional patient underwent NLB for a new radiographic abnormality at a separate location in the ipsilateral breast, which was invasive ductal carcinoma. SCB appears to be an effective alternative to NLB for the majority of patients deemed eligible. Careful mammographic follow-up is warranted for these patients given the small, but real, possibility of sampling error.
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Affiliation(s)
- B Pitre
- Department of Surgery (Section of Surgical Oncology), Medical University of South Carolina, Charleston 29425, USA
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Baron PL, Aabakken LE, Cole DJ, LeVeen MB, Baron LF, Daniel DM, Cunningham JT, Hawes RH, Adams DB, Hoffman BJ. Differentiation of benign from malignant pancreatic masses by endoscopic ultrasound. Ann Surg Oncol 1997; 4:639-43. [PMID: 9416411 DOI: 10.1007/bf02303748] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [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: 02/05/2023]
Abstract
BACKGROUND It is often difficult to determine whether a mass in the pancreas is benign or malignant. The goal was to evaluate whether endoscopic ultrasound (EUS) can reliably establish whether a mass is benign or malignant. METHODS One hundred five patients with possible pancreatic tumors were referred for EUS. Those who were found to have a lesion suspicious for carcinoma and did not have a known malignancy also underwent EUS-guided FNA. RESULTS A mass suspicious for cancer was identified in 73 patients, whereas inflammatory changes or a normal pancreas was noted in 32 patients. Four of the latter 32 patients were subsequently found to have cancer. EUS-guided FNA was performed on 47 of the 73 patients with a suspicious mass and was read as cancer in 27 patients, atypia in 10 patients, and benign in 10 patients. All 10 patients with atypia were subsequently confirmed to have cancer, and 6 of the 10 patients with a benign FNA were proved to have a tumor at surgery. EUS could differentiate the lesion as malignant with a sensitivity of 95%, specificity 88%, positive predictive value 95%, and negative predictive value 88%. CONCLUSIONS Radial array EUS is helpful in supporting or refuting a diagnosis of cancer in a patient with a pancreatic mass. Although EUS-guided FNA can confirm the diagnosis, a negative FNA should not preclude exploration when clinically indicated.
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Affiliation(s)
- P L Baron
- Dept. of Surgery, Medical University of South Carolina, Charleston 29425, USA
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Kulling D, Green J, Pai GS, Baron PL, Baker SS, Lewin D, Hoffman BJ. Familial adenomatous polyposis registry in South Carolina. J S C Med Assoc 1997; 93:405-9. [PMID: 9394082] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D Kulling
- Department of Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston 29425, USA
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Bhutani MS, Hawes RH, Baron PL, Sanders-Cliette A, van Velse A, Osborne JF, Hoffman BJ. Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy 1997; 29:854-8. [PMID: 9476770 DOI: 10.1055/s-2007-1004321] [Citation(s) in RCA: 177] [Impact Index Per Article: 6.6] [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] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the accuracy, safety, and clinical utility of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of pancreatic masses. METHODS Forty-seven patients were referred for EUS with a pancreatic mass and suspicion of pancreatic cancer based upon painless obstructive jaundice, epigastric abdominal pain plus weight loss/anorexia, or idiopathic pancreatitis. All patients underwent EUS with both radial (Olympus UM20) and linear array (Pentax FG32-UA) systems. After TNM staging by EUS, ultrasound directed FNA of the pancreatic mass was performed using a 23 gauge, 4 cm long needle. RESULTS EUS-guided FNA was performed in all 47 patients. Results: successful targeting = 100%, adequate cellularity = 100%, FINDINGS adeno Ca = 25, squamous cell Ca = 1, lymphoma = 1, poorly differentiated Ca= 1, atypical cytology or suspicious for carcinoma = 9, no malignant cells = 10. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-guided pancreatic FNA for the diagnosis of malignancy was 64%, 100%, 100% and 16% respectively. CONCLUSIONS EUS with FNA is useful for detection of malignancy in a pancreatic mass. The procedure appears to have a complication rate of 2%. Impact of this technique on clinical management of patients needs further evaluation.
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Tagge DU, Baron PL. Giant adrenal cyst: management and review of the literature. Am Surg 1997; 63:744-6. [PMID: 9247446] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The diagnosis of adrenal cysts is becoming increasingly more common with the widespread use of diagnostic imaging modalities. Most adrenal cysts are asymptomatic and less than 10 cm in diameter when discovered incidentally. Symptoms appear when adrenal cysts enlarge sufficiently to cause pain and gastrointestinal disturbances or become palpable. In this report, we present a case of a giant 45-cm right adrenal cyst manifesting as painless abdominal distention in a 23-year-old female. This case appears to be one of the largest adrenal cysts reported to date. The classification and management of adrenal cystic lesions is reviewed.
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Affiliation(s)
- D U Tagge
- Department of Surgery, Medical University of South Carolina, Charleston, USA
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Schweinfest CW, Graber MW, Chapman JM, Papas TS, Baron PL, Watson DK. CaSm: an Sm-like protein that contributes to the transformed state in cancer cells. Cancer Res 1997; 57:2961-5. [PMID: 9230209] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A novel gene encoding a protein containing Sm motif-like domains was found to have elevated expression in pancreatic cancer and in several cancer-derived cell lines. CaSm (for Cancer-associated Sm-like) mRNA is up-regulated in 87.5% (seven of eight) of pancreatic tumor/normal pairs. Similarly, cell lines from cancers originating in liver, ovary, lung, and kidney show increased CaSm expression compared to their normal tissue cognates. CaSm encodes a 133-amino acid open reading frame that contains the two Sm motifs found in the common snRNP proteins, with the greatest homology to the Sm G protein (60% similarity). Two hypothetical proteins from Caenorhabditis elegans and Saccharomyces cerevisiae share even greater similarity (72.8 and 67.7%, respectively), suggesting a broad family of proteins containing Sm motifs. Antisense CaSm RNA is able to alter the transformed phenotype of pancreatic cancer cells by reducing their ability to form large colonies in soft agar when compared to untransfected cells. Therefore, CaSm expression appears to be necessary for maintenance of the transformed state.
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Affiliation(s)
- C W Schweinfest
- Center for Molecular and Structural Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston 29425, USA
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Conti G, Stoll G, Scarpini E, Baron PL, Bianchi R, Livraghi S, Scarlato G. p75 neurotrophin receptor induction and macrophage infiltration in peripheral nerve during experimental diabetic neuropathy: possible relevance on regeneration. Exp Neurol 1997; 146:206-11. [PMID: 9225754 DOI: 10.1006/exnr.1997.6521] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [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: 02/04/2023]
Abstract
In this study we examined the expression of the neurotrophin receptor p75 (p75NTR) and the activation of macrophages in the sciatic nerve of rats at different time points after the induction of diabetes with streptozotocin (STZ). Northern blot and immunocytochemical analysis showed that p75NTR was not detectable in the sciatic nerve by Week 2 after STZ treatment. At this time, single nerve fiber immunostaining using ED1 monoclonal antibody revealed that active macrophages were infiltrating the endoneurium, which had a normal morphological aspect. By Weeks 5 and 15 p75NTR mRNA and protein were induced in the endoneurium of diabetic animals. Immunocytochemical analysis of teased single nerve fibers showed that p75NTR protein was distributed uniformly along isolated fibers with no pathological evidence of axonal degeneration or myelin disruption. At this time, cells of the phagocyte lineage had already disappeared from the nerve. These data show that during experimental diabetic neuropathy, the endoneurial induction of p75NTR is localized along isolated nerve fibers showing no morphological alterations, and in time, follows the recruitment of active macrophages in the nerve, suggesting that these cells, directly or through their products, can influence p75NTR induction. This process might play an important role in STZ diabetic neuropathy, as a response to decreased levels of neurotrophins such as NGF and promoting nerve regeneration in the early phases of the disease.
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MESH Headings
- Animals
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Diabetic Neuropathies/metabolism
- Diabetic Neuropathies/pathology
- Encephalomyelitis, Autoimmune, Experimental/metabolism
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Immunohistochemistry
- Macrophages/pathology
- Nerve Fibers/metabolism
- Nerve Fibers/pathology
- Protein Biosynthesis
- RNA, Messenger/biosynthesis
- Rats
- Rats, Inbred Lew
- Rats, Sprague-Dawley
- Receptor, Nerve Growth Factor
- Receptors, Nerve Growth Factor/biosynthesis
- Sciatic Nerve/metabolism
- Sciatic Nerve/pathology
- Time Factors
- Transcription, Genetic
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Affiliation(s)
- G Conti
- Institute of Neurology, Dino Ferrari Center, University of Milan, IRCCS Ospedale Maggiore Policlinico, Italy
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Baron PL, Gates CE, Reed CE, Dikeman RL, Drosieko JJ, Passmore RN, Bromberg JS, Willingham MC. p53 overexpression in squamous cell carcinoma of the esophagus. Ann Surg Oncol 1997; 4:37-45. [PMID: 8985516 DOI: 10.1007/bf02316809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 02/03/2023]
Abstract
BACKGROUND Coastal South Carolina has a high incidence of squamous cell carcinoma of the esophagus (SCCE) among black residents. Overexpression and mutations of the p53 tumor suppressor gene have been noted in SCCE from other high-incidence regions. The purpose of this study was to determine the frequency of p53 overexpression in this region both in patients with SCCE and in normal subjects. METHODS Normal and malignant tissue obtained at esophagoscopy and normal esophageal mucosa (NEM) from random autopsies were studied with monoclonal antibodies to the p53 gene product. Total cellular RNA was extracted from SCCE, reverse transcribed to complementary DNA, and a portion of the p53 gene was amplified via polymerase chain reaction and sequenced. RESULTS Immunohistochemical studies on SCCE from nine patients showed that six (67%) were positive, two (22%) were negative, and one was indeterminate for p53 overexpression. The corresponding normal samples showed that three (33%) had p53-positive cells in the basal epithelial layer, whereas six did not. NEM from 18 random forensic cases displayed p53 overexpression in seven (39%). Eight of the nine tumors had p53 mutations. CONCLUSIONS p53 overexpression and mutations are frequently found in SCCE from patients in coastal South Carolina. Overexpression in normal epithelium from random autopsy cases may indicate an inherited or acquired predisposition in this geographic region.
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Affiliation(s)
- P L Baron
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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Baron PL. The surgical management of melanoma: from diagnosis to local treatment. Semin Oncol 1996; 23:714-8. [PMID: 8970592] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is critical for physicians who may play a role in the diagnosis of melanoma to be knowledgeable of how to approach a suspicious nevus. A full thickness of tissue is necessary to microstage the melanoma and thereby guide subsequent treatment decisions. The past two decades have witnessed a dramatic change in the surgical management of this disease in that the margin of excision seems to be constantly shrinking. Well-conducted randomized studies have shown conclusively that narrower margins are sufficient for thin and intermediate thickness melanomas. Thus, the survival is comparable with that achieved for more radical excisions with less functional and cosmetic deficit.
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Affiliation(s)
- P L Baron
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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Cole DJ, Baron PL. Surgical management of patients with intermediate thickness melanoma: current role of elective lymph node dissection. Semin Oncol 1996; 23:719-24. [PMID: 8970593] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The appropriate role of elective hymph node dissection (ELND) in patients with clinical stage I intermediate thickness melanoma lesions remains a dilemma. Despite an impressive number of carefully performed nonrandomized/retrospective studies and two criticized multi-institutional prospective randomized trials, a clear benefit from ELND is still debatable. As a result, there currently is no standard approach for selecting patients who should undergo this procedure. Further prospective trials performed by the Intergroup/National Cancer Institute and World Health Organization (WHO) Melanoma groups, addressing Intermediate thickness extremity and truncal lesions respectively, have recently been completed. No long-term survival data is yet available from either group. Potentially conflicting preliminary results recently presented noted a significant ELND survival advantage for a subgroup of men with axial lesions in the Intergroup study, and no differential in survival demonstrable for the World Health Organization study at a median follow-up of 4 years. One area of agreement among surgeons on either side of the controversy is the need to be able to identify in a minimally invasive manner stage I-II melanoma patients with clinically occult lymph node metastases from the population at risk. Technologies such as polymerase chain reaction and lymphoscintigraphy to improve our ability to detect clinically occult lymph node metastases and facilitate the identification of sentinel node(s) for selective lymphadenectomy hold some promise. Although more research needs to be performed, these approaches potentially would allow for a more directed application of ELND in a much smaller number of melanoma patients. This could provide an entirely novel and more effective approach to the manner in which we evaluate patients with intermediate thickness melanoma lesions and would decrease the significance of this controversy. It is hoped that the long-term data about the appropriate role of ELND from the current prospective trials will provide definitive information on which to base decisions, or that current research will fundamentally alter our approach to these patients. In the interim, surgeons must continue to make their best judgments about the management of regional lymph nodes in an individual patient setting based on prior experience or personal bias.
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Affiliation(s)
- D J Cole
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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Cole DJ, Wilson MC, Baron PL, O'Brien P, Reed C, Tsang KY, Schlom J. Phase I study of recombinant CEA vaccinia virus vaccine with post vaccination CEA peptide challenge. Hum Gene Ther 1996; 7:1381-94. [PMID: 8818725 DOI: 10.1089/hum.1996.7.11-1381] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- D J Cole
- MUSC Dept. of Surgery, Charleston, South Carolina, 29425, USA
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Abstract
BACKGROUND The genetic alterations that occur in the transformation of normal esophageal mucosa (NEM) to carcinoma of the esophagus (CAE) are not well understood. Differential display of mRNA is a recently described technique that uses reverse transcription and PCR to compare cDNA from paired normal and malignant tissue to determine whether there is either genetic loss (putative tumor suppressor gene) or overexpression (putative oncogene) in malignant cells. Our goal was to identify some of these genes from patients with CAE. METHODS Specimens of NEM and corresponding CAE were obtained from patients at endoscopy or surgical resection and immediately snap frozen. Total RNA was isolated, reverse transcribed to cDNA, and PCR amplified with a predefined 10-mer oligonucleotide. The products were displayed on a polyacrylamide gel. Differential bands were isolated and sequenced and/or used as probes for Northern analysis. RESULTS Application of the differential display method resulted in the isolation of 49 cDNA clones from three patients with CAE. Sequencing of the clones has revealed five unique sequences not previously reported and one that has been identified as histone H3.3. Northern analysis of histone H3.3 has revealed overexpression in four of six CAEs but not the paired NEM. In addition, whereas only 5 of 13 normal human cell lines of various origins overexpressed this gene, 11 of 12 human cancer cell lines (9 of 9 adenocarcinomas) overexpressed it. CONCLUSIONS Differential display can be used to isolate potential oncogenes and tumor suppressor genes. We have identified five unique sequences and one known gene that may contribute to the development of CAE.
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Affiliation(s)
- M W Graber
- Department of Surgery, Hollings Cancer Center, Charleston, South Carolina, USA
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Bhatia M, Baron PL, Alderman DF, Gordon L. False-positive imaging of In-111 labeled monoclonal antibody conjugate CYT-103 in a patient with metastatic colorectal carcinoma. Clin Nucl Med 1995; 20:979-80. [PMID: 8565379 DOI: 10.1097/00003072-199511000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 01/31/2023]
Abstract
In-111 satumomab whole-body imaging is used in the evaluation of patients with colorectal carcinoma. The authors report a case of false-positive In-111 localization in a nonfunctional adrenal adenoma in a patient with metastatic colon carcinoma.
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Affiliation(s)
- M Bhatia
- Department of Radiology, Medical University of South Carolina, Charleston 29425, USA
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Conti G, Baron PL, Scarpini E, Vedeler C, Rostami A, Pleasure D, Scarlato G. Low-affinity nerve growth factor receptor expression in sciatic nerve during P2-peptide induced experimental allergic neuritis. Neurosci Lett 1995; 199:135-8. [PMID: 8584242 DOI: 10.1016/0304-3940(95)12043-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Northern blot, immunocytochemistry, and single nerve fiber immunostaining were used to determine the expression of low-affinity nerve growth factor (NGF) receptor (p75NGFR) in the peripheral nervous system of Lewis rats during the course of experimental allergic neuritis (EAN) induced with 100 micrograms of 'SP26' synthetic peptide, corresponding to residues 53-78 of bovine P2 myelin protein. This severe reversible polyneuropathy, characterized by extensive multifocal demyelination in nerve roots, and axonal degeneration within sciatic nerve, represents a useful tool to investigate Schwann cell gene expression in these different pathological conditions. Our results showed that both p75NGFR mRNA and protein were induced within sciatic nerve by day 18 and 23 after 'SP26' immunization. By this time, however, p75NGFR was not detectable in roots of cauda equina. These data demonstrate that, during EAN induced by immunization with 100 micrograms of 'SP26', p75NGFR is up-regulated in Schwann cells and in nerve fibers distally along the nerve. This suggests that the induction of the receptor in sciatic nerve during P2-peptide EAN is related to the loss of axonal contact by Schwann cells.
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Affiliation(s)
- G Conti
- Institute of Neurology, Dino Ferrari Center, University of Milan, Italy
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48
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Abstract
PURPOSE There is an increasing awareness of local procedures to treat early stage rectal cancer. Abdominoperineal resection (APR) or low anterior resection (LAR) has been recommended if adverse pathologic findings are encountered in the local excision specimen. No data compare the impact on survival of "immediate" resection for adverse features vs. "salvage" resection for clinical recurrence. METHODS We reviewed retrospectively 155 patients who underwent initial curative treatment of invasive rectal cancer by excision (91), snare-cautery (44), and fulguration (20). RESULTS Twenty-one patients underwent APR/LAR immediately after initial local treatment, whereas another 21 patients underwent salvage APR/LAR for local recurrence. The disease-free survival after APR/LAR was 94.1 percent for the immediate group and 55.5 percent for the delayed group (P < 0.05). CONCLUSION This decreased survival observed after delayed resection supports the recommendation for immediate APR/LAR when adverse pathologic features are present in the excision specimen.
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Affiliation(s)
- P L Baron
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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49
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Abstract
Patients with cancer of the lower third of the rectum can avoid both the morbidity of an APR and the need for a permanent colostomy by having the cancer removed by local excision. If the surgeon clinically suspects that a patient has an early cancer, the first step should be local excision of the tumor. The pathological features of the cancer specimen will then indicate the next step in treatment. This can range from no further therapy to proctectomy with or without an anastomosis (Table 2). Patients with a low risk of local failure can be treated by excision alone. Those with a higher risk of local failure should undergo APR or LAR or enter a protocol to determine the role of local excision and adjuvant chemoradiation.
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Affiliation(s)
- P L Baron
- Department of Surgery, Medical University of South Carolina, Charleston 29425, USA
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50
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Benedict S, Williams RD, Baron PL. Recalled anxiety: from discovery to diagnosis of a benign breast mass. Oncol Nurs Forum 1994; 21:1723-7. [PMID: 7854934] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE/OBJECTIVES To determine the amount of anxiety recalled by women who have had benign breast biopsies and to describe coping strategies used by these women during the time from discovery of the mass to definitive diagnosis. DESIGN Descriptive, retrospective. SETTING Surgical oncology practices, private and academic, treating patients living in five southern states. SAMPLE 238 women who had excisional biopsies with benign results within the previous two years. Mean age of 52 years, 80% Caucasian, and 20% African American. METHODS Subjects rated their anxiety from discovery to diagnosis on a 16-point visual analogue scale and answered a short-answer question about the coping strategies used to deal with the anxiety. MAIN RESEARCH VARIABLES Anxiety and coping strategies. FINDINGS The mean length of time from discovery to diagnosis was 35 days. No statistically significant relationship was found between the length of time from discovery to diagnosis and the amount of anxiety experienced. However, 58% of the women recalled severe amounts of anxiety during this time. Qualitative analysis grouped coping strategies into five patterns (themes): diversionary, spiritual, interpersonal, hopeful, and avoidance. CONCLUSIONS The time between discovery of a breast mass and definitive diagnosis is a time of considerable anxiety for many women. Substantial time elapses between discovery and diagnosis, contributing to the possible morbidity associated with severe anxiety. IMPLICATIONS FOR NURSING PRACTICE Nurses can work to decrease the time occupied by the diagnostic process, counsel women regarding the anxiety being experienced, and present coping strategies that may help.
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Affiliation(s)
- S Benedict
- College of Nursing, Medical University of South Carolina, Charleston
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