T. Singh

Detection and prognostic impact of micrometastasis in colorectal cancer.

Review of literature was performed on studies with prognostic impact of micrometastasis in colorectal cancer. Among 16 studies included, micrometastasis was detected in 26.5% of patients. Most analysis revealed that micrometastasis carries a poorer prognosis compared to node negative disease (NND). The results of those studies were compared with our pilot study of 109 patients with colon cancer, showing improved prognosis of micrometastasis after being upstaged and treated with chemotherapy when compared with NND. J. Surg. Oncol. 2011;103:534–537.

Use of diagnostic testing for patients with early-stage breast cancer in a multi-hospital quality collaborative in Michigan.

242 Background: In 2012, ASCO identified five opportunities to improve the quality of cancer care and reduce costs. Two of these recommendations focused on limiting use of advanced diagnostic imaging with computed tomography (CT), Positron Emission Tomography (PET), and radionuclide bone scans (BS) at diagnosis and during surveillance for women with early stage breast cancer with a low risk of metastasis. We describe the use of diagnostic imaging among patients with early stage breast cancer treated at hospitals in Michigan. METHODS The Michigan Breast Oncology Quality Initiative is a collaboration between Michigan hospitals, the University of Michigan Comprehensive Cancer Center, and the National Comprehensive Cancer Network (NCCN). This collaborative collects longitudinal demographic, staging, treatment, and follow up data using the NCCN Breast Outcomes Database platform. We analyzed use of advanced diagnostic testing with CT, PET, BS and contrast it with use of traditional imaging (mammography/ultrasound) at diagnosis and during follow up in patients with stage 0, I, II breast cancer between 1998 to 2009. Patients who died or recurred were excluded. RESULTS The cohort included 7,632 patients (19.6% stage 0, 48.1% stage I, 32.3% stage II) treated at 17 hospitals. Use of traditional imaging was documented in nearly 100% of patients at diagnosis and throughout the follow up period. With respect to advanced diagnostic imaging, 20.3 % underwent CT, 4.7% underwent PET, and 11.6% underwent BS at diagnosis. Advanced testing use decreased over time (Table). CONCLUSIONS Despite published guidelines, which recommend against their routine use, advanced diagnostic imaging use was prevalent among patients treated for early breast cancer at MiBOQI hospitals. Education efforts should target physicians and patients on the lack of proven benefit and potential risks of using advanced diagnostic imaging in this population. [Table: see text].

Comparative analysis of CT scan, PET scan, and CT angioportogram with intraoperative ultrasound in detecting liver metastases.

e14626 Background: Open, laparoscopic, or percutaneous radiofrequency ablation (RFA) of liver metastases (mets) requires accurate preoperative (preop) localization through CT scan, PET and/or CT an...

Bowel involvement in advanced epithelial ovarian cancer as a prognostic factor

16536 Background: Epithelial Ovarian cancer (OvCa) often presents in advanced stages(stage IIIC and IV). Bowel involvement (BI) at the time of the diagnosis suggests bulky advanced disease and has ...

Aggressiveness of papillary serous carcinoma (PSC) of the uterus and ovary: A need for reappraisal

5177 Background: PSC of the uterus (Ut) and ovary (Ov) are often treated similarly because of known similarities in their histology, biological aggressiveness and poor outcomes. In order to identify the need for more standardized treatment, the outcome of PSC of the Ut and Ov were compared in regard to their clinical presentation, treatment, stage at diagnosis, recurrence pattern and survival within the same institution. Methods: From 1991–2004, 327 consecutive patients (pts) were treated for Ut and Ov malignancy by a single oncologic surgeon. Of these, 46 pts were diagnosed as PSC (Ut =14 pts and Ov = 32 pts). The data were obtained from medical records, tumor registry, and follow-up reports. Comparisons were made in regard to age, stage at diagnosis, presentation, treatment, recurrence pattern and disease-free and overall survival. Results: See table. Conclusions: Ovarian PSC presents at a much more advanced stage, recurs more often and has much poorer disease-free and overall survival than uterine PSC....

Comparative analysis of recurrence in colon cancer (Cca) for patients (pts) undergoing sentinel lymph node (SLN) mapping vs. conventional (conv.) surgery

3566 Background: SLN mapping (M) upstages upto 20% of Cca pts. Upstaged pts may benefit from adjuvant chemotherapy (CT), thus reducing the chances of recurrence. Routine pathological examination after conv. surgery understages 15-20% of pts with Cca. The purpose of our trial was to compare the patterns of recurrence in Cca pts undergoing SLNM vs Conv. SURGERY METHODS Group A pts underwent SLNM with 1% Lymphazurin. Group B pts underwent conv. SURGERY SLNs were examined by 5 microsections for H&E & 1 for immunohistochemistry. The other nonSLNs in group A and all LNs in group B were examined by routine methods. All pts had median follow-up of 5yrs and minimum follow-up of 2yrs. Data was collected for no. of LNs, tumor and nodal status and recurrence patterns. RESULTS There were 106 pts in group A and 145 pts in group B. T stage distribution for group A and B were as follows: 13.2% vs 7.6% (T1), 23.6% vs 13.8% (T2), 56.6% vs 69.6% (T3) and 6.6% vs 8.9% (T4) respectively. SLNM was successful in 100% of pts with accuracy of 96%, sensitivity of 92% . SLNM upstaged 15% of pts with micromets which would have been missed by conv. METHODS Table1 shows number of LNs, incidence of nodal mets and overall recurrences. For stage I (T1,T2,N0) pts, the recurrence in group A was 2.6% vs 13%( p <0.004) in group B. All these 4 recurrences in group B occurred in N0 pts, thereby suggesting possible missed micromets, hence untreated and thus may explain the increased incidence of recurrence 23.4% vs 4.7% in group A. CONCLUSIONS SLNM is simple and accurate in determining nodal mets. Compared to Conv. surgery, SLNM upstages a significant no. of pts whose disease may remain undetected by conv. METHODS Pts thus upstaged by SLNM could receive adjuvant CT resulting in a further decrease in recurrence and perhaps prolong survival. [Figure: see text] No significant financial relationships to disclose.

Comparative analysis of bone marrow micrometastases with sintinel lymph node (SLN) status in early breast cancer S. Saha, D. Iddings, J. Bevenour, R. Aravapalli, A. Kunadi, S. Rajurkar, D. Wiese, T. Singh, M. Arora, T. Branigan

S: POSTER PRESENTATIONS tomy in rural areas. Opportunities exist to increase breast conservation rates through improved access to care and increased use of accelerated partial breast radiotherapy (XRT or brachytherapy) as an alternative to routine whole breast