Rachel Wooldridge

Impact of weight change during neoadjuvant chemotherapy on pathologic response in triple‐negative breast cancer

Triple‐negative breast cancer (TNBC) is an uncommon but aggressive subtype of breast cancer. Obesity has been associated with an increased risk of breast cancer and worse prognosis. Some studies suggest that obese patients are less likely to achieve pathologic complete response (pCR) to neoadjuvant chemotherapy (NCT) and experience worse overall survival. Ki‐67 is a proliferation marker that correlates with tumor aggressiveness. The goal of this study was to examine the impact of weight change during NCT for TNBC on pathologic response and Ki‐67 reduction. Retrospective review identified 173 TNBC patients treated between 2004 and 2011. Data were collected on patient demographics, pre‐ and post‐NCT body mass index (BMI), Ki‐67, and pCR. Data analysis was performed using the two‐tailed Students t‐test, analysis of variance (ANOVA), and Fishers exact test. Sixty‐six patients met final study criteria. Forty‐three patients lost weight during chemotherapy and 23 gained weight. Patients in the weight gain group were significantly younger (P = 0.0013). There was no significant difference between the two groups in terms of Ki‐67 reduction (P = 0.98) or pCR (P = 0.58). When patients were separated into normal weight (BMI<25 kg/m2), overweight (BMI ≥ 25 and <30 kg/m2), and obese (BMI ≥ 30 kg/m2), there was no significant difference in Ki‐67 among those groups either before or after NCT. The degree of obesity did not have a significant impact on Ki‐67 reduction. Weight change during NCT does not appear to correlate with Ki‐67 change or achieving pCR in TNBC. This may reflect the nature of this subtype of breast cancer that is less responsive to the hormonal effects that adipose tissue exerts on cancer cell proliferation.

Bracketed radioactive seed localization vs bracketed wire‐localization in breast surgery

Multiple localizers placed in a bracketed fashion facilitates excision of radiographically extensive breast lesions. In this study, bracketed radioactive seed localization (bRSL) was compared to bracketed wire localization (bWL). We hypothesized that bRSL would achieve adequate margins and decrease re‐operation rates with similar or less specimen volumes (SV) than bWL. Retrospective review identified patients who underwent bracketed breast procedures at an academic medical center. Data collected included patient demographics, tumor features, treatment variables, and surgical outcomes. Wilcoxon rank‐sum test and chi‐square test were used to compare continuous and categorical data, respectively. A multivariable logistic regression model was used to evaluate the association between re‐excision and localization technique after adjusting for clinically relevant variables. Patients who underwent bWL were 3.9 times more likely to undergo re‐excision compared to patients in bRSL group (OR=3.9, 95% CI: 2.0‐7.4). Initial and total SV did not significantly differ between the two groups (P=.4). Patients were significantly more likely to undergo a mastectomy in the bWL group than in the bRSL group (24% vs 7%; P<.01). For patients undergoing excision of radiologically extensive breast lesions, bRSL serves as an alternative to bWL. In this retrospective study, bRSL was associated with a decreased re‐excision rate with similar SV and a lower rate of mastectomy when compared to bWL.

Magnetic resonance imaging characteristics of granulomatous mastitis

Granulomatous mastitis (GM) is a benign chronic inflammatory condition of the breast. This study was performed to determine the utility of magnetic resonance imaging (MRI) in differentiating GM from malignancy. MRI findings in 12 women with clinical or histopathologically-proven GM were retrospectively reviewed. Non-mass enhancement on MRI was present in all 12 patients with clustered ring enhancement being the most common pattern (n=7, 58%). Architectural distortion (n=10, 83%), skin thickening (n=10, 83%) and focal skin enhancement (n=10, 83%) were also very common. MRI features of GM are often identical to features considered suspicious for malignancy on MRI.

Large Malignant Phyllodes Tumor of the Breast with Metastases to the Lungs

Phyllodes tumors of the breast account for less than 0.5% of breast cancers and present most commonly in women 45 to 49 years old. The importance in managing fibroepithelial lesions lies in distinguishing fibroadenomas, which are benign, from phyllodes tumors, which can be malignant and require complete surgical excision. We report the case of a 56-year-old female who presented with a rapidly enlarging mass in her right breast 18 cm in maximum dimension that completely effaced the breast and distorted the nipple. The patient underwent a successful total mastectomy after core biopsy revealed a diagnosis of phyllodes tumor. Surgical resection is the primary treatment modality; neoadjuvant and adjuvant therapies remain controversial. Here, we report the case of a large malignant phyllodes tumor metastatic to the lungs, review the literature, and discuss diagnostic modalities and adjunct nonsurgical therapies.

Oncoplastic Techniques for Breast Conservation

Oncoplastic breast surgery techniques have been developed over the past several years, allowing for improved cosmesis and bilateral symmetry in the setting of an oncologically sound procedure. Techniques including the combination of a partial mastectomy with a reduction mammoplasty, lateral or medial approaches, parenchymal rearrangement surgery, and flexible pedicle-based reconstructions are all appropriate for a general surgeon to master.