1
|
Bestepe F, Ghanem GF, Fritsche CM, Weston J, Sahay S, Mauro AK, Sahu P, Tas SM, Ruemmele B, Persing S, Good ME, Chatterjee A, Huggins GS, Salehi P, Icli B. MicroRNA-409-3p/BTG2 signaling axis improves impaired angiogenesis and wound healing in obese mice. FASEB J 2024; 38:e23459. [PMID: 38329343 DOI: 10.1096/fj.202302124rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
Wound healing is facilitated by neoangiogenesis, a complex process that is essential to tissue repair in response to injury. MicroRNAs are small, noncoding RNAs that can regulate the wound healing process including stimulation of impaired angiogenesis that is associated with type-2 diabetes (T2D). Expression of miR-409-3p was significantly increased in the nonhealing skin wounds of patients with T2D compared to the non-wounded normal skin, and in the skin of a murine model with T2D. In response to high glucose, neutralization of miR-409-3p markedly improved EC growth and migration in human umbilical vein endothelial cells (HUVECs), promoted wound closure and angiogenesis as measured by increased CD31 in human skin organoids, while overexpression attenuated EC angiogenic responses. Bulk mRNA-Seq transcriptomic profiling revealed BTG2 as a target of miR-409-3p, where overexpression of miR-409-3p significantly decreased BTG2 mRNA and protein expression. A 3' untranslated region (3'-UTR) luciferase assay of BTG2 revealed decreased luciferase activity with overexpression of miR-409-3p, while inhibition had opposite effects. Mechanistically, in response to high glucose, miR-409-3p deficiency in ECs resulted in increased mTOR phosphorylation, meanwhile BTG-anti-proliferation factor 2 (BTG2) silencing significantly decreased mTOR phosphorylation. Endothelial-specific and tamoxifen-inducible miR-409-3p knockout mice (MiR-409IndECKO ) with hyperglycemia that underwent dorsal skin wounding showed significant improvement of wound closure, increased blood flow, granulation tissue thickness (GTT), and CD31 that correlated with increased BTG2 expression. Taken together, our results show that miR-409-3p is a critical mediator of impaired angiogenesis in diabetic skin wound healing.
Collapse
Affiliation(s)
- Furkan Bestepe
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - George F Ghanem
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Colette M Fritsche
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - James Weston
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sumedha Sahay
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Amanda K Mauro
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Parul Sahu
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sude M Tas
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Brooke Ruemmele
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sarah Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Miranda E Good
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gordon S Huggins
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Basak Icli
- Department of Medicine, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Pawlak N, De La Cruz Ku G, Chatterjee A, Persing S, Homsy C. The Keystone Perforator Island Flap: Review of Utility and Versatile Clinical Applications. Plast Reconstr Surg Glob Open 2024; 12:e5556. [PMID: 38322809 PMCID: PMC10846774 DOI: 10.1097/gox.0000000000005556] [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] [Received: 02/27/2023] [Accepted: 10/03/2023] [Indexed: 02/08/2024]
Abstract
Background The keystone perforator island flap (KPIF) was described almost a decade ago. However, this flap has only recently been recognized for its advantages in various clinical applications in plastic surgery. A better understanding of the versatility of KPIFs can help promote the widespread adoption of this technique for complex wounds in various anatomical regions. Methods A retrospective chart review was conducted of patients undergoing KPIFs from December 2018 to March 2022 at the authors' home institution. The indications, surgical approaches, patient characteristics, and outcomes were extracted for review and analysis. Results A total of 12 patients (ages 13-86 years) underwent reconstruction with KPIFs for oncologic and nononcologic defects. By anatomic region, three cases involved the upper back, six involved the lumbosacral region, one involved the perineum, and two involved the midfoot. Half of the patients (n = 6) had failed previous attempts at wound closure. The mean defect size was 13.8 × 10.0 cm for the upper back lesions, 13.7 × 4.8 for the lumbosacral defects, and 3.5 × 2.0 for the metatarsal wounds. Median follow-up time for all patients was 7.5 months (IQR: 4-10.5). On follow-up, there was 100% flap survival. Conclusion KPIFs are a simple, safe, and suitable option for reconstructive closure of defects in many anatomical areas, including wounds complicated by previous failed closure attempts, with low complication risk profile.
Collapse
Affiliation(s)
- Natalie Pawlak
- From the Tufts University School of Medicine, Boston, Mass
| | - Gabriel De La Cruz Ku
- Department of General Surgery, University of Massachusetts, Worcester, Mass
- Universidad Cientifica del Sur, Lima, Peru
| | | | - Sarah Persing
- Department of Plastic Surgery, Tufts Medical Center, Boston, Mass
| | | |
Collapse
|
3
|
Gaffney KA, Bloom JA, Moon T, Wareham C, Song C, Pawlak N, Homsy C, Persing S, Chatterjee A, Chen L. Poor accessibility to consumer pricing exists for elective hernia repair surgery. Am J Surg 2023; 226:610-615. [PMID: 37438177 DOI: 10.1016/j.amjsurg.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/09/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Hospital price transparency is federally mandated to improve consumer accessibility. We aimed to evaluate how hospitals were complying with these regulations for elective hernia repairs. METHODS Searches were performed for different hospital systems in attempt to find a price for the procedure using author's own health insurance. Data collected included time to reach the cost estimate tool, time to obtain price estimates, and price ranges. With prices for inguinal and ventral hernia repairs varying across the state's medical centers. RESULTS Fourteen medical centers across the country were included, all had a cost estimate calculator. The average success rate of obtaining a cost for inguinal hernia was 48%. Comparatively, the average success rate of obtaining a cost for ventral hernia was 12%. Of the successful searches for price, significant variation exists amongst the accessed hernia procedure cost. CONCLUSION Despite federal mandates for hospital price transparency, online cost-estimate calculators are underperforming, thus exposing a need for more accessible cost-estimates for patients undergoing elective hernia repair.
Collapse
Affiliation(s)
- Kerry A Gaffney
- Tufts Medical Center, Department of Surgery, Boston, MA, USA.
| | - Joshua A Bloom
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | - Tina Moon
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | - Carly Wareham
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | | | | | | | - Sarah Persing
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | | | - Lilian Chen
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| |
Collapse
|
4
|
Nardello SM, Bloom JA, Gaffney KA, Singhal M, Persing S, Chatterjee A. Practical oncoplastic surgery techniques needed for practice. Ann Transl Med 2023; 11:383. [PMID: 37970600 PMCID: PMC10632567 DOI: 10.21037/atm-23-1536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/27/2023] [Indexed: 11/17/2023]
Abstract
Oncoplastic breast surgery (OPS) is a form of breast conservation surgery that includes immediate breast reconstruction. OPS has previously been shown to be a safe and effective treatment for breast cancer. In a special series on Breast Reconstruction, we aimed to describe oncoplastic breast reconstruction options and the corresponding technical details. Sections were divided by descriptions of OPS specific preoperative workup, volume displacement techniques, volume replacement techniques, and postoperative considerations. In addition, to sharing expert surgical pearls gained through performing OPS procedures over the years. Innovations in breast reconstruction offer women treatment options that are both oncologically safe and aesthetically preferred. The rise in reconstructive procedures is changing how patients make decisions based on their diagnosis. The ultimate surgical decision should be determined by the patient's anatomy, patient's personal preferences, tumor characteristics, and clinical presentation in a shared decision-making fashion with a multidisciplinary team. However, with both volume displacement and volume replacement techniques, women of all breast sizes can achieve an aesthetic outcome without sacrificing oncologic resection.
Collapse
Affiliation(s)
- Salvatore M Nardello
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Joshua A Bloom
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Kerry A Gaffney
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Meera Singhal
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Sarah Persing
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
5
|
Jonczyk MM, Karamchandani M, Zaccardelli A, Bahadur A, Fisher CS, Czerniecki B, Margenthaler JA, Persing S, Homsy C, Nardello S, O'Brien J, Losken A, Chatterjee A. External Validation of the Breast Cancer Surgery Risk Calculator (BCSRc): A Predictive Model for Postoperative Complications. Ann Surg Oncol 2023; 30:6245-6253. [PMID: 37458950 DOI: 10.1245/s10434-023-13904-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The breast cancer surgical risk calculator (BCSRc) is a prognostic tool that determines a breast cancer patient's unique risk of acute complications following each possible surgical intervention. When used in the preoperative setting, it can help to stratify patients with an increased complication risk and enhance the patient-physician informed decision-making process. The objective of this study was to externally validate the four models used in the BCSRc on a large cohort of patients who underwent breast cancer surgery. METHODS The BCSRc was developed by using a retrospective cohort from the National Surgical Quality Improvement Program database from 2005 to 2018. Four models were built by using logistic regression methods to predict the following composite outcomes: overall, infectious, hematologic, and internal organ complications. This study obtained a new cohort of patients from the National Surgical Quality Improvement Program by utilizing participant user files from 2019 to 2020. The area under the curve, brier score, and Hosmer-Lemeshow goodness of fit test measured model performance, accuracy, and calibration, respectively. RESULTS A total of 192,095 patients met inclusion criteria in the development of the BCSRc, and the validation cohort included 60,144 women. The area under the curve during external validation for each model was approximately 0.70. Accuracy, or Brier scores, were all between 0.04 and 0.003. Model calibration using the Hosmer-Lemeshow statistic found all p-values > 0.05. All of these model coefficients will be updated on the web-based BCSRc platform: www.breastcalc.org . CONCLUSIONS The BCSRc continues to show excellent external-validation measures. Collectively, this prognostic tool can enhance the decision-making process, help stratify patients with an increased complication risk, and improve expectant management.
Collapse
Affiliation(s)
- Michael M Jonczyk
- Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA.
| | | | | | | | - Carla Suzanne Fisher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Persing
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | - Christopher Homsy
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Julie O'Brien
- Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | |
Collapse
|
6
|
Jonczyk MM, Karamchandani M, Zaccardelli A, Bahadur A, Fisher CS, Czerniecki B, Margenthaler JA, Persing S, Homsy C, Nardello S, O'Brien J, Losken A, Chatterjee A. ASO Visual Abstract: External Validation of the Breast Cancer Surgery Risk Calculator (BCSRc): A Predictive Model for Postoperative Complications. Ann Surg Oncol 2023; 30:6254-6255. [PMID: 37523117 DOI: 10.1245/s10434-023-14044-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Affiliation(s)
- Michael M Jonczyk
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
| | | | | | | | - Carla Suzanne Fisher
- Department of Surgery, Indiana University School of Medicine Indianapolis, Indianapolis, IN, USA
| | | | - Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Persing
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | - Christopher Homsy
- Department of General Surgery, Tufts Medical Center, Boston, MA, USA
| | | | - Julie O'Brien
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | |
Collapse
|
7
|
Pawlak N, Karamchandani M, Wareham C, Gaffney K, Zaccardelli A, Nardello S, Persing S, Chatterjee A, Homsy C. Comparing oncoplastic breast reduction with immediate symmetry surgery to standard breast reduction surgery: Are postoperative complications worse? J Surg Oncol 2022; 126:956-961. [PMID: 35801636 DOI: 10.1002/jso.27009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Oncoplastic breast reduction mammoplasty (ORM) is an excellent treatment option for women with breast cancer and macromastia undergoing breast conservation therapy. Here, we aim to better understand the risks associated with ORM compared to standard reduction mammoplasty (SRM). METHODS A retrospective chart review was performed of patients undergoing ORM or SRM from 2015 to 2021. Primary outcomes included the occurrence of major or minor postoperative complications in the two groups and delays to adjuvant therapy (>90 days) among the women undergoing ORM. RESULTS Women in the ORM group (n = 198) were significantly older (p < 0.001) with a higher prevalence of smoking (p < 0.001), diabetes mellitus (p < 0.01), and a Charlson comorbidity index ≥ 3 (p < 0.001) compared to women undergoing SRM (n = 177). After controlling for potential confounders, there were no significant between-group differences in the odds of developing postoperative complications (odds ratio = 0.80, 95% confidence interval: 0.36-1.69). Only 3% (n = 4) of the 150 women undergoing adjuvant radiation or chemotherapy experienced delays related to postoperative complications. CONCLUSION ORM has a similar safety profile as SRM, despite the older age and higher number of comorbidities often seen in patients undergoing ORM, and is a safe option for achieving contralateral symmetry at the time of partial mastectomy without delays to adjuvant therapy.
Collapse
Affiliation(s)
- Natalie Pawlak
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Kerry Gaffney
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Salvatore Nardello
- Department of Surgery, Tufts Medical Center Community Care, Boston, Massachusetts, USA
| | - Sarah Persing
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Christopher Homsy
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Kang I, Deshpande K, Persing S, Yin J, Xiu J, Korn WM, Zeng J, Roussos-Torres ET, Lu J, Spicer D, Sener SF, Tan AR, Sumrall A, Hoon DSB, Ma CX, Anders CK, McArthur HL, Basho R, Lenz HJ, Neman J. Abstract PD6-06: Comprehensive characterization of neurotransmitters and neuronal signaling gene alterations in invasive breast cancers. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd6-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUNDIt has been reported that the sympathetic nervous system and associated neurotransmitters (NTs) play a pivotal role in driving breast cancer (BC) tumorigenesis and metastasis, however, comprehensive characterization of these pathways in BC is lacking. The purpose of this study was to retrospectively characterize NTs and neuronal signaling (NTNS) gene alterations in a large real-world BC cohort. METHODS A total of 6464 BC tumors were analyzed by next generation sequencing (NextSeq, 592 genes and WES, NovaSEQ, 720 genes) and whole transcriptome sequencing (WTS, NovaSeq) at Caris Life Sciences. Gene set variation analysis (GSVA) scores were calculated (positive: higher gene expressions in a selected gene set compared to genes outside that gene set in each tumor specimen, vice versa for negative) to assess expression of major NTNS genes, including GABA, nicotinic (NIC), muscarinic (MUS), dopamine (DA), reelin (RELN), and glial cell line-derived neurotrophic factor (GDNF). GSVA scores were compared by histologic subtype, primary or metastatic site, and hormone receptor (HR) and HER2 status with corrected Wilcoxon-Mann-Whitney testing. All significance levels were p<0.01. RESULTS The 6464 BC specimens in this cohort included 2520 primary sites and 3944 metastasis (mets) (liver: 1012; lymph node: 714; bone: 575; lung: 420; brain: 196). Predictive biomarker status in this cohort was HR+/HER2-: 3705; HR+/HER2+: 238; HR-/HER2+: 189; TNBC: 1654. Invasive ductal carcinomas (IDC) were the most common histologic subtype and demonstrated significantly higher GSVA scores for RELN and NIC pathways with respect to invasive lobular carcinomas (ILC) (Table). TNBC tumors had significantly higher enrichment overall (GABA, -0.04 vs -0.14; RELN, -0.05 vs -0.31; DA, -0.03 vs -0.08; MUS, 0.13 vs -0.16; NIC, 0.01 vs -0.12; and GDNF, 0.04 vs -0.04). HR-/HER2+ had significantly higher scores in GABA, -0.04 vs -0.14; RELN, -0.03 vs -0.31; MUS, 0.12 vs -0.16; and NIC, -0.01 vs -0.12 genes. Brain mets had significantly enriched pathway scores for GABA, 0.30 vs -0.13; MUS, 0.15 vs -0.08; and NIC, 0.13 vs -0.09 compared to primary tumors. Similarly, GABA,0.09 vs -0.13; DA, 0.07 vs -0.05; MUS, 0.17 vs -0.08; and NIC, 0.02 vs -0.09 pathways were enriched in bone mets compared to those from primary tumors. CONCLUSION Our results demonstrate that NTNS pathways are significantly enriched in IDC, TNBC tumors, and particularly in brain and bone mets. Our data advance the current understanding of the role of NTNS pathways in BC tumorigenesis and metastasis. Further investigation on genetic. determinants and signaling alternations associated with the observed NTNS pathway deregulation is warranted and could inform the development of novel therapeutic strategies. Significant comparisons with Bonferroni corrected p values are shown with an asterisk.
Citation Format: Irene Kang, Krutika Deshpande, Sarah Persing, Jun Yin, Joanne Xiu, Wolfgang Michael Korn, Jia Zeng, Evanthia T Roussos-Torres, Janice Lu, Darcy Spicer, Stephen F Sener, Antoinette R Tan, Ashley Sumrall, David SB Hoon, Cynthia X Ma, Carey K Anders, Heather L McArthur, Reva Basho, Heinz-Josef Lenz, Josh Neman. Comprehensive characterization of neurotransmitters and neuronal signaling gene alterations in invasive breast cancers [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD6-06.
Collapse
Affiliation(s)
- Irene Kang
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Jun Yin
- Caris Life Sciences, Phoenix, AZ
| | | | | | - Jia Zeng
- Caris Life Sciences, Phoenix, AZ
| | | | - Janice Lu
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Darcy Spicer
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Stephen F Sener
- Los Angeles County and USC (LAC+USC) Medical Center, Los Angeles, CA
| | | | | | | | - Cynthia X Ma
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Reva Basho
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - Heinz-Josef Lenz
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Josh Neman
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| |
Collapse
|
9
|
Xun H, Lee E, Yesantharao P, El Eter L, Kraezlin F, Persing S, Sacks J. Reconstructive and restorative cues improve public perception on the value of plastic and reconstructive surgeries. J Plast Reconstr Aesthet Surg 2021; 74:2947-2956. [PMID: 33992560 DOI: 10.1016/j.bjps.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/22/2020] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Persistent public misconceptions of plastic and reconstructive surgery (PRS), ambiguity between cosmetic versus reconstructive surgical procedures, and subjective interpretation of aesthetics can result in undervaluing of the field. Our study analyzes how patient context (cosmetic or reconstructive/restorative cues) affect public perception of outcomes and value of surgery. METHODS We distributed Qualtrics™ surveys to laypersons via Amazon Mechanical Turk. Demographics were self-reported. The survey presented a series of pre- and post-operative photographs of PRS surgeries alongside either a cosmetic or reconstructive/restorative cue, followed by questions on values of procedure. Survey responses were analyzed using two-tailed Student's t tests and chi square analyses, univariate and multivariate analysis, and linear regression. RESULTS Of the 459 respondents, the mean age was 38.5 ± 12.1 years, and was 50.5% (232) male. The majority of respondents classified breast reconstruction as a cosmetic surgery (243, 66.8%), and was rated more attractive (p < 0.0005), higher impact on self-esteem (p < 0.001), and to be covered by health insurance (p < 0.0001) compared to breast augmentation. Reconstructive cued breast and facial procedures were viewed more favorably; the exception was gynecomastia reduction. Reconstructive classification had significant positive correlation with support for insurance coverage (R2 = 0.8268) and willingness to pursue (R2 = 0.5328). CONCLUSIONS This study revealed more public support for reconstructive/restorative cued PRS cases over cosmetic cued PRS cases, and persistent misconceptions of breast reconstruction as a cosmetic procedure. Reconstructive or restorative cues can be used to educate the public and address skewed perceptions on the roles and value of PRS.
Collapse
Affiliation(s)
- Helen Xun
- Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, United States.
| | - Erica Lee
- Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, United States
| | - Pooja Yesantharao
- Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, United States
| | - Leen El Eter
- Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, United States
| | - Franca Kraezlin
- Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, United States
| | - Sarah Persing
- Johns Hopkins School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore, MD, United States
| | - Justin Sacks
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States.
| |
Collapse
|
10
|
Yesantharao P, Lee E, Kraenzlin F, Persing S, Chopra K, Shetty PN, Xun H, Sacks J. Surgical block time satisfaction: A multi-institutional experience across twelve surgical disciplines. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.pcorm.2020.100128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Ayouty M, Sekigami Y, Kraus N, Persing S, Naber S, Aleali S, Nardello S, Chatterjee A. Managing Positive Margins After Oncoplastic Surgery. Am Surg 2020; 88:2058-2060. [PMID: 32927994 DOI: 10.1177/0003134820950679] [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: 11/17/2022]
Affiliation(s)
- Mohyee Ayouty
- 1810 Tufts University School of Medicine, Boston, MA, USA
| | | | - Nicholas Kraus
- 1810 Tufts University School of Medicine, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
12
|
Darrach H, Yesantharao PS, Persing S, Kokosis G, Carl HM, Bridgham K, Seu M, Stifler S, Sacks JM. Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation. J Reconstr Microsurg 2020; 36:606-615. [DOI: 10.1055/s-0040-1713667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background Postmastectomy secondary lymphedema can cause substantial morbidity. However, few studies have investigated longitudinal quality of life (QoL) outcomes in patients with postmastectomy lymphedema, especially with regard to surgical versus nonoperative management. This study prospectively investigated QoL in surgically versus nonsurgically managed patients with postmastectomy upper extremity lymphedema.
Methods This was a longitudinal cohort study of breast cancer-related lymphedema patients at a single institution, between February 2017 and January 2020. Lymphedema Quality of Life Instrument (LyQLI) and RAND-36 QoL instrument were used. Mann–Whitney U and Fisher's exact tests were used for descriptive statistics. Wilcoxon's signed-rank testing and linear modeling were used to analyze longitudinal changes in QoL.
Results Thirty-two lymphedema patients were recruited to the study (20 surgical and 12 nonsurgical). Surgical and nonsurgical cohorts did not significantly differ in clinical/demographic characteristics or baseline QoL scores, but at the 12-month time point surgical patients had significantly greater LyQLI overall health scores than nonsurgical patients (79.3 vs. 58.3, p = 0.02), as well as higher composite RAND-36 physical (68.5 vs. 38.3, p = 0.04), and mental (77.0 vs. 52.7, p = 0.02) scores. Furthermore, LyQLI overall health scores significantly improved over time in surgical patients (60.0 at baseline vs. 79.3 at 12 months, p = 0.04). Besides surgical treatment, race, and age were also found to significantly impact QoL on multivariable analysis.
Conclusion Our results suggest that when compared with nonoperative management, surgery improved QoL for chronic, secondary upper extremity lymphedema patients within 12-month postoperatively. Our results also suggested that insurance status may have influenced decisions to undergo lymphedema surgery. Further study is needed to investigate the various sociodemographic factors that were also found to impact QoL outcomes in these lymphedema patients.
Collapse
Affiliation(s)
- Halley Darrach
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pooja S. Yesantharao
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Persing
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George Kokosis
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hannah M. Carl
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly Bridgham
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Seu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samantha Stifler
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin M. Sacks
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| |
Collapse
|
13
|
|
14
|
Persing S, Timberlake A, Madari S, Steinbacher D. Three-Dimensional Imaging in Rhinoplasty: A Comparison of the Simulated versus Actual Result. Aesthetic Plast Surg 2018; 42:1331-1335. [PMID: 29789868 DOI: 10.1007/s00266-018-1151-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/29/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Computer imaging has become increasingly popular for rhinoplasty. Three-dimensional (3D) analysis permits a more comprehensive view from multiple vantage points. However, the predictability and concordance between the simulated and actual result have not been morphometrically studied. The purpose of this study was to aesthetically and quantitatively compare the simulated to actual rhinoplasty result. METHODS A retrospective review of 3D images (VECTRA, Canfield) for rhinoplasty patients was performed. Images (preop, simulated, and actual) were randomized. A blinded panel of physicians rated the images (1 = poor, 5 = excellent). The image series considered "best" was also recorded. A quantitative assessment of nasolabial angle and tip projection was compared. Paired and two-sample t tests were performed for statistical analysis (P < 0.05 as significant). RESULTS Forty patients were included. 67.5% of preoperative images were rated as poor (mean = 1.7). The simulation received a mean score of 2.9 (good in 60% of cases). 82.5% of actual cases were rated good to excellent (mean 3.4) (P < 0.001). Overall, the panel significantly preferred the actual postoperative result in 77.5% of cases compared to the simulation in 22.5% of cases (P < 0.001). The actual nasal tip was more projected compared to the simulations for both males and females. There was no significant difference in nasal tip rotation between simulated and postoperative groups. CONCLUSION 3D simulation is a powerful communication and planning tool in rhinoplasty. In this study, the actual result was deemed more aesthetic than the simulated image. Surgeon experience is important to translate the plan and achieve favorable postoperative results. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Sarah Persing
- Yale New Haven Hospital, Section of Plastic and Reconstructive Surgery, New Haven, CT, USA
- Yale University, Section of Plastic Surgery, 333 Cedar Street, 3rd Floor, New Haven, CT, 06511, USA
| | - Andrew Timberlake
- Yale University, Section of Plastic Surgery, 333 Cedar Street, 3rd Floor, New Haven, CT, 06511, USA
| | - Sarika Madari
- Yale University, Section of Plastic Surgery, 333 Cedar Street, 3rd Floor, New Haven, CT, 06511, USA
| | - Derek Steinbacher
- Yale New Haven Hospital, Section of Plastic and Reconstructive Surgery, New Haven, CT, USA.
- Yale University, Section of Plastic Surgery, 333 Cedar Street, 3rd Floor, New Haven, CT, 06511, USA.
| |
Collapse
|
15
|
Timberlake AT, Choi J, Zaidi S, Lu Q, Nelson-Williams C, Brooks ED, Bilguvar K, Tikhonova I, Mane S, Yang JF, Sawh-Martinez R, Persing S, Zellner EG, Loring E, Chuang C, Galm A, Hashim PW, Steinbacher DM, DiLuna ML, Duncan CC, Pelphrey KA, Zhao H, Persing JA, Lifton RP. Two locus inheritance of non-syndromic midline craniosynostosis via rare SMAD6 and common BMP2 alleles. eLife 2016; 5. [PMID: 27606499 PMCID: PMC5045293 DOI: 10.7554/elife.20125] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022] Open
Abstract
Premature fusion of the cranial sutures (craniosynostosis), affecting 1 in 2000 newborns, is treated surgically in infancy to prevent adverse neurologic outcomes. To identify mutations contributing to common non-syndromic midline (sagittal and metopic) craniosynostosis, we performed exome sequencing of 132 parent-offspring trios and 59 additional probands. Thirteen probands (7%) had damaging de novo or rare transmitted mutations in SMAD6, an inhibitor of BMP – induced osteoblast differentiation (p<10−20). SMAD6 mutations nonetheless showed striking incomplete penetrance (<60%). Genotypes of a common variant near BMP2 that is strongly associated with midline craniosynostosis explained nearly all the phenotypic variation in these kindreds, with highly significant evidence of genetic interaction between these loci via both association and analysis of linkage. This epistatic interaction of rare and common variants defines the most frequent cause of midline craniosynostosis and has implications for the genetic basis of other diseases. DOI:http://dx.doi.org/10.7554/eLife.20125.001 The bones in the front, back and sides of the human skull are not fused to one another at birth in order to allow the brain to double in size during the first year of life and continue growing into adulthood. However, one in 2,000 infants is born with a condition called craniosynostosis in which some of these bones have already fused. This fusion prevents the skull from growing properly, and can lead to the brain becoming compressed. As such, surgeons routinely undo the fusion in these infants to allow the brain and skull to grow normally. Eighty-five percent of craniosynostosis cases occur in infants with no other abnormalities, (called non-syndromic cases) and most have no other affected family member. It has therefore been unclear whether these infants have craniosynostosis due to a genetic or non-genetic cause. If the cause is genetic, it is also not clear whether a mutation in a single gene, the combined effects of many genes, or something in between is responsible. Now, by focusing on a group of 191 infants with premature fusion of bones joined at the midline of the skull, Timberlake et al. asked if any of the approximately 20,000 genes in the human genome were altered more frequently in these infants than would be expected by chance. This search revealed that rare mutations that disable one copy of a gene called SMAD6 in combination with a common DNA variant near another gene called BMP2 account for about 7% of infants with midline forms of craniosynostosis. These genes are both known to regulate how bones form, which explains how the mutation of these genes could lead to craniosynostosis. In all cases, the parents of these children were unaffected. This was typically because one parent had only the SMAD6 mutation while the other had only the common BMP2 variant; the transmission of both to their offspring resulted in craniosynostosis. The finding that a rare mutation’s effect is strongly modified by a common variant from another site in the genome is unprecedented. These findings will allow doctors to counsel families about the risk of having additional children with craniosynostosis. Timberlake et al. next plan to study more patients with craniosynostosis to identify additional genes that contribute to this disease. They will also look at other diseases to see whether the combination of rare mutation and common DNA variant could be behind other unexplained disorders. DOI:http://dx.doi.org/10.7554/eLife.20125.002
Collapse
Affiliation(s)
- Andrew T Timberlake
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, United States.,Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Jungmin Choi
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, United States
| | - Samir Zaidi
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, United States
| | - Qiongshi Lu
- Department of Biostatistics, Yale University School of Medicine, New Haven, United States
| | - Carol Nelson-Williams
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, United States
| | - Eric D Brooks
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Kaya Bilguvar
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Yale Center for Genome Analysis, New Haven, United States
| | | | - Shrikant Mane
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Yale Center for Genome Analysis, New Haven, United States
| | - Jenny F Yang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Rajendra Sawh-Martinez
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Sarah Persing
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Elizabeth G Zellner
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Erin Loring
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, United States.,Yale Center for Genome Analysis, New Haven, United States
| | - Carolyn Chuang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Amy Galm
- Craniosynostosis and Positional Plagiocephaly Support, New York, United States
| | - Peter W Hashim
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Derek M Steinbacher
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Michael L DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, United States
| | - Charles C Duncan
- Department of Neurosurgery, Yale University School of Medicine, New Haven, United States
| | - Kevin A Pelphrey
- Child Study Center, Yale University School of Medicine, New Haven, United States
| | - Hongyu Zhao
- Department of Biostatistics, Yale University School of Medicine, New Haven, United States
| | - John A Persing
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, United States
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, United States.,Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, United States.,Yale Center for Genome Analysis, New Haven, United States.,The Rockefeller University, New York, United States
| |
Collapse
|
16
|
Brooks ED, Yang J, Beckett JS, Lacadie C, Scheinost D, Persing S, Zellner EG, Oosting D, Keifer C, Friedman HE, Wyk BV, Jou RJ, Sun H, Gary C, Duncan CC, Constable RT, Pelphrey KA, Persing JA. Normalization of brain morphology after surgery in sagittal craniosynostosis. J Neurosurg Pediatr 2016; 17:460-8. [PMID: 26684766 PMCID: PMC7182140 DOI: 10.3171/2015.7.peds15221] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECT Nonsyndromic craniosynostosis (NSC) is associated with significant learning disability later in life. Surgical reconstruction is typically performed before 1 year of age to correct the cranial vault morphology and to allow for normalized brain growth with the goal of improving cognitive function. Yet, no studies have assessed to what extent normalized brain growth is actually achieved. Recent advances in MRI have allowed for automated methods of objectively assessing subtle and pronounced brain morphological differences. The authors used one such technique, deformation-based morphometry (DBM) Jacobian mapping, to determine how previously treated adolescents with sagittal NSC (sNSC) significantly differ in brain anatomy compared with healthy matched controls up to 11.5 years after surgery. METHODS Eight adolescent patients with sNSC, previously treated via whole-vault cranioplasty at a mean age of 7 months, and 8 age- and IQ-matched control subjects without craniosynostosis (mean age for both groups = 12.3 years), underwent functional 3-T MRI. Statistically significant group tissue-volume differences were assessed using DBM, a whole-brain technique that estimates morphological differences between 2 groups at each voxel (p < 0.01). Group-wise Jacobian volume maps were generated using a spacing of 1.5 mm and a resolution of 1.05 × 1.05 × 1.05 mm(3). RESULTS There were no significant areas of volume reduction or expansion in any brain areas in adolescents with sNSC compared with controls at a significance level of p < 0.01. At the more liberal threshold of p < 0.05, two areas of brain expansion extending anteroposteriorly in the right temporooccipital and left frontoparietal regions appeared in patients with sNSC compared with controls. CONCLUSIONS Compared with previous reports on untreated infants with sNSC, adolescents with sNSC in this cohort had few areas of brain dysmorphology many years after surgery. This result suggests that comprehensive cranioplasty performed at an early age offers substantial brain normalization by adolescence, but also that some effects of vault constriction may still persist after treatment. Specifically, few areas of expansion in frontoparietal and temporooccipital regions may persist. Overall, data from this small cohort support the primary goal of surgery in allowing for more normalized brain growth. Larger samples, and correlating degree of normalization with cognitive performance in NSC, are warranted.
Collapse
Affiliation(s)
| | - Jenny Yang
- Section of Plastic and Reconstructive Surgery
| | - Joel S Beckett
- Department of Neurosurgery, University of California, Los Angeles, California; and
| | | | | | | | | | - Devon Oosting
- Center for Translational Developmental Neuroscience, Child Study Center, and
| | - Cara Keifer
- Center for Translational Developmental Neuroscience, Child Study Center, and
| | - Hannah E Friedman
- Center for Translational Developmental Neuroscience, Child Study Center, and
| | - Brent Vander Wyk
- Center for Translational Developmental Neuroscience, Child Study Center, and
| | - Roger J Jou
- Center for Translational Developmental Neuroscience, Child Study Center, and
| | - Haosi Sun
- Section of Plastic and Reconstructive Surgery
| | - Cyril Gary
- Section of Plastic and Reconstructive Surgery
| | - Charles C Duncan
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - R Todd Constable
- Department of Diagnostic Radiology, and.,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut;,Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Kevin A Pelphrey
- Center for Translational Developmental Neuroscience, Child Study Center, and
| | | |
Collapse
|
17
|
Persing S, Jerome MA, James TA, Callas P, Mace J, Sowden M, Goodwin A, Weaver DL, Sprague BL. Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates? Breast 2015; 24:618-22. [PMID: 26199197 PMCID: PMC4752196 DOI: 10.1016/j.breast.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/08/2015] [Accepted: 06/21/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Margin status is important in guiding decisions to re-excise following breast-conserving surgery (BCS) for breast cancer. The College of American Pathologists (CAP) developed guidelines to standardize pathology reporting; however, compliance with margin documentation guidelines has been shown to vary. The aim of this retrospective study was to determine whether compliance with CAP guidelines affects re-excision and mastectomy rates. METHODS We identified 1423 patients diagnosed with breast cancer between 1998 and 2006 who underwent BCS with negative margins. CAP compliance was categorized as maximal, minimal, or non-compliant. Statistical analyses were performed comparing the frequency of re-excision and mastectomy after initial BCS according to CAP margin reporting guideline compliance. Data were adjusted for provider facility by including a clustering variable within the regression model. RESULTS Patients with non-compliant margin reporting were 1.7 times more likely to undergo re-excision and/or mastectomy than those with maximally compliant reporting. Level of compliance was most strongly associated with the frequency of mastectomy; non-compliant margin reporting was associated with a 2.5-fold increase in mastectomy rates compared to maximally compliant reporting. The results did not substantially change when the analyses accounted for clustering at the provider facility level. CONCLUSIONS Our findings suggest that compliance with CAP guidelines in pathology reporting may be associated with variation in re-excision and mastectomy rates following BCS.
Collapse
Affiliation(s)
| | - Mairin A Jerome
- The University of Vermont College of Medicine, Burlington, VT, USA
| | - Ted A James
- The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA
| | - Peter Callas
- The University of Vermont College of Medicine, Burlington, VT, USA
| | - John Mace
- The University of Vermont College of Medicine, Burlington, VT, USA
| | - Michelle Sowden
- The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA
| | - Andrew Goodwin
- The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA
| | - Donald L Weaver
- The University of Vermont College of Medicine, Burlington, VT, USA; Fletcher Allen Health Care, Burlington, VT, USA
| | - Brian L Sprague
- The University of Vermont College of Medicine, Burlington, VT, USA
| |
Collapse
|
18
|
Persing S, James TA, Mace J, Goodwin A, Geller B. Variability in the quality of pathology reporting of margin status following breast cancer surgery. Ann Surg Oncol 2011; 18:3061-5. [PMID: 21947586 PMCID: PMC3661000 DOI: 10.1245/s10434-011-1916-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Received: 04/18/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Accurately determining margin status is important for breast cancer treatment. The College of American Pathologists (CAP) developed guidelines to standardize reporting of margin status. The aim of this study is to determine statewide concordance with CAP breast cancer reporting guidelines for margin status. METHODS The Vermont Breast Cancer Surveillance System (VBCSS) tracks mammography-related services provided to all women treated for breast cancer at hospitals in Vermont. These data include accompanying pathology reports, which were analyzed for descriptions of margin status. The CAP protocols have both requirements and recommendations for margin status reporting. Reports were "minimally compliant" if they adhered to the requirements stated in the CAP protocols or "maximally compliant" if they included the recommended protocols in addition to those required. RESULTS There were 2,016 reports that met the inclusion criteria. A total of 71.1% were minimally compliant and 37.3% were maximally compliant with the CAP guideline standards. There was a statistically significant rise in compliant reports, with minimally compliant reports increasing from 55.7% in 1998 to 79.3% in 2006, and maximally compliant reports rising from 4.7% in 1998 to 53.7% in 2006 (χ(2) trend test, P < 0.001) for both cohorts. CONCLUSIONS Reporting of margin status in breast-conserving surgery varies widely. There is a significant rise in guideline compliance with margin status reporting from 1998 to 2006; however, overall compliance remains suboptimal. This study provides evidence to support the need for quality improvement measures in the implementation of CAP guidelines for reporting margin status following breast-conserving surgery.
Collapse
Affiliation(s)
- Sarah Persing
- The University of Vermont College of Medicine, Burlington, VT, USA
| | | | | | | | | |
Collapse
|