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  1. Article ; Online: When Leaning In Becomes Unhealthy, Can We Fix It?

    Diego, Emilia J / Carty, Sally E

    JAMA surgery

    2021  Volume 156, Issue 10, Page(s) 915–916

    MeSH term(s) Cardiopulmonary Resuscitation ; Humans
    Language English
    Publishing date 2021-07-28
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2021.3302
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  2. Article ; Online: ASO Author Reflections: Improvement in Postoperative Pain, Nausea, and Vomiting After Implementation of an Enhanced Recovery Protocol for Breast Surgery.

    Dinh, Kate H / Diego, Emilia J

    Annals of surgical oncology

    2020  Volume 27, Issue Suppl 3, Page(s) 713–714

    MeSH term(s) Antiemetics ; Breast Neoplasms/surgery ; Enhanced Recovery After Surgery ; Female ; Humans ; Mastectomy/adverse effects ; Mastectomy/methods ; Nausea/etiology ; Pain, Postoperative/etiology ; Vomiting/etiology
    Chemical Substances Antiemetics
    Language English
    Publishing date 2020-08-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-020-09011-6
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    Zs.A 4042: Show issues Location:
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  3. Article: Use of natural language understanding to facilitate surgical de-escalation of axillary staging in patients with breast cancer.

    Carleton, Neil / Saadawi, Gilan / McAuliffe, Priscilla F / Soran, Atilla / Oesterreich, Steffi / Lee, Adrian V / Diego, Emilia J

    medRxiv : the preprint server for health sciences

    2024  

    Abstract: Natural language understanding (NLU) may be particularly well-equipped for enhanced data capture from the electronic health record (EHR) given its examination of both content- and context-driven extraction. We developed and applied a NLU model to examine ...

    Abstract Natural language understanding (NLU) may be particularly well-equipped for enhanced data capture from the electronic health record (EHR) given its examination of both content- and context-driven extraction. We developed and applied a NLU model to examine rates of pathological node positivity (pN+) and rates of lymphedema to determine if omission of routine axillary staging could be extended to younger patients with ER+/cN0 disease. We found that rates of pN+ and arm lymphedema were similar between patients 55-69yo and ≥70yo, with rates of lymphedema exceeding rates of pN+ for clinical stage T1c and smaller disease. Data from our NLU model suggest that omission of SLNB might be extended beyond Choosing Wisely recommendations, limited to those over 70 years old, to all postmenopausal women with early-stage ER+/cN0 disease. These data support the recently-reported SOUND trial results and provide additional granularity to facilitate surgical de-escalation.
    Language English
    Publishing date 2024-02-06
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2024.02.03.24302095
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  4. Article ; Online: Margin Management and Adjuvant Therapy for Phyllodes Tumors: Practice Patterns of the American Society of Breast Surgeons Members.

    Diego, Emilia J / Rosenberger, Laura H / Deng, Xiaoyan / McGuire, Kandace P

    Annals of surgical oncology

    2022  Volume 29, Issue 10, Page(s) 6151–6161

    Abstract: Background: Phyllodes tumors (PTs) are rare breast neoplasms with variable clinical behavior by histologic type: benign, borderline, or malignant. Until recently, management guidelines recommended one approach for all subtypes.: Methods: A 21- ... ...

    Abstract Background: Phyllodes tumors (PTs) are rare breast neoplasms with variable clinical behavior by histologic type: benign, borderline, or malignant. Until recently, management guidelines recommended one approach for all subtypes.
    Methods: A 21-question survey was sent to American Society of Breast Surgeon members to evaluate management patterns by subtype. Surgeon demographics, decisions regarding management of margins, re-excision, surveillance, and synoptic reporting were collected. Chi-square or analysis of variance (ANOVA) were used as appropriate, with significance set at p < 0.05.
    Results: A total of 493 of 2969 surveys were completed for a response rate of 18.3%. Among the survey takers, 55% were fellowship trained, 72% were in practice > 10 years, and 82% performed > 100 breast cases per year. Although 25% of respondents enucleate a mass with clinical suspicion of a PT alone, this decreased to 18% if a preoperative core biopsy performed was suggestive of PT. For margin management, 47% do not re-excise positive margins for benign PTs, but 96% would for a borderline or malignant PTs (p < 0.001). Only 2% perform axillary staging for malignant PTs, and 90% refer borderline or malignant PTs for radiation. Two-year surveillance was performed by about half of respondents for benign PT. However, two-thirds of respondents would increase surveillance to 5 years for borderline or malignant PTs. Only 38% report a templated synoptic pathology report at their institution.
    Conclusion: PT management patterns are evolving but still variable when looking at initial margin intent, decision for re-excision, radiation referral, pathologic reporting, and surveillance. This suggests the need for more specific management guidelines by subtype given differences in clinical behavior.
    MeSH term(s) Biopsy, Large-Core Needle ; Breast Neoplasms/epidemiology ; Breast Neoplasms/surgery ; Female ; Humans ; Margins of Excision ; Neoplasm Recurrence, Local/epidemiology ; Phyllodes Tumor/surgery ; Surgeons
    Language English
    Publishing date 2022-07-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-022-12192-x
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    Zs.A 4042: Show issues Location:
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  5. Article ; Online: Cost-effectiveness of Choosing Wisely guidelines for axillary observation in women older than age 70 years with hormone receptor-positive, clinically node-negative, operable breast tumors.

    Hrebinko, Katherine A / Bryce, Cindy L / Downs-Canner, Stephanie / Diego, Emilia J / Myers, Sara P

    Cancer

    2022  Volume 128, Issue 12, Page(s) 2258–2268

    Abstract: Background: The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population. Recent analyses reveal that this has not been widely adopted. The purpose of this ... ...

    Abstract Background: The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population. Recent analyses reveal that this has not been widely adopted. The purpose of this cost-effectiveness analysis is to compare the costs and benefits associated with observation or SLNB in women >70 years old with hormone receptor-positive, clinically node-negative, operable breast cancer.
    Methods: A decision tree with Markov modeling was created to compare treatment strategies using long-term follow-up data from clinical trials in this population. Costs were estimated from published literature and publicly available databases. Breast cancer-specific health-state utilities were derived from the literature and expert opinion. One-way, 2-way, and probabilistic sensitivity analyses were conducted. A structural sensitivity analysis was performed to assess the effect of functional status and anxiety from nonevaluation of the axilla on cost-effectiveness. Costs and benefits, measured in life-years (LYs) and quality-adjusted life-years (QALYs), were tabulated across 10, 15, and 20 years and compared using incremental cost-effectiveness ratios (ICERs).
    Results: SLNB is not cost-effective from the payer or societal perspectives with ICERs of $138,374/LY and $131,900/LY, respectively. When QALYs were considered, SLNB provided fewer QALYs (SLNB, 10.33 QALYs; observation, 10.53 QALYs) at a higher cost (SLNB, $15,845; observation, $4020). Structural sensitivity analysis revealed that SLNB was cost-effective in certain patients with significant anxiety related to axillary observation (ICER, $39,417/QALY).
    Conclusions: Routine SLNB in this population is not cost-effective. The cost-effectiveness of SLNB, however, is dependent on individual patient factors, including functional status as well as patient preference.
    MeSH term(s) Aged ; Axilla/pathology ; Breast Neoplasms/pathology ; Cost-Benefit Analysis ; Female ; Humans ; Lymph Node Excision ; Quality-Adjusted Life Years ; Sentinel Lymph Node Biopsy
    Language English
    Publishing date 2022-04-07
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1429-1
    ISSN 1097-0142 ; 0008-543X ; 1934-662X
    ISSN (online) 1097-0142
    ISSN 0008-543X ; 1934-662X
    DOI 10.1002/cncr.34207
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    Uh III Zs.146: Show issues Location:
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  6. Article ; Online: Single-institution outcomes after excision of benign phyllodes tumors: low recurrence risk even with positive margins.

    Balogun, Zainab / Steiman, Jennifer G / Schwartz, Jandie L / Lee, Joanna S / Soran, Atilla / Johnson, Ronald R / McAuliffe, Priscilla F / Diego, Emilia J

    Breast cancer research and treatment

    2023  Volume 198, Issue 3, Page(s) 569–572

    Abstract: Purpose: Benign phyllodes tumors (BPT) are rare breast neoplasms with clinical behavior that poses low recurrence risk. Guidelines regarding appropriate margins recommend surgical excision to negative margins, sometimes requiring re-excision surgery. ... ...

    Abstract Purpose: Benign phyllodes tumors (BPT) are rare breast neoplasms with clinical behavior that poses low recurrence risk. Guidelines regarding appropriate margins recommend surgical excision to negative margins, sometimes requiring re-excision surgery. Contemporary experience suggests that re-excision in the face of positive margins may not be needed.
    Methods: This is a retrospective review of a single-institution experience with BPT from 2010 to 2019 with 102 patients. Demographics, outcomes and follow-up were analyzed.
    Results: The median age was 37 years. 95% had a pre-operative biopsy and only 6% were confirmed BPT before surgery.56% had positive margins and were more likely to be younger and have a pre-operative diagnosis of fibroadenoma. The median follow-up was 33 months. Between the positive and negative margin groups, recurrence rates were not significantly different (p = 0.87).
    Conclusion: Positive margins on excision of BPT poses a low recurrence risk and re-excision surgery is not necessary.
    MeSH term(s) Humans ; Adult ; Female ; Phyllodes Tumor/surgery ; Phyllodes Tumor/pathology ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/surgery ; Neoplasm Recurrence, Local/pathology ; Margins of Excision ; Biopsy ; Retrospective Studies
    Language English
    Publishing date 2023-02-20
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-023-06885-4
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    Zs.A 1655: Show issues Location:
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  7. Article: Case report of a large lactating adenoma with rapid antepartum enlargement.

    Teng, Cindy Y / Diego, Emilia J

    International journal of surgery case reports

    2016  Volume 20, Page(s) 127–129

    Abstract: Introduction: Lactating adenomas are rare benign breast tumors, most commonly found during pregnancy and lactation. They are usually slow growing and smaller than 3cm in maximal diameter. Rare cases of giant lactating adenomas and rapid postpartum ... ...

    Abstract Introduction: Lactating adenomas are rare benign breast tumors, most commonly found during pregnancy and lactation. They are usually slow growing and smaller than 3cm in maximal diameter. Rare cases of giant lactating adenomas and rapid postpartum enlargement have been reported, but none have shown a giant lactating adenoma with rapid antepartum enlargement or antepartum surgical management.
    Case presentation: A 27 year-old pregnant woman presented at 28 weeks gestation with a 5cm left breast mass that doubled to 10cm within six weeks and was increasingly tender. Histopathologic examination of a core biopsy was consistent with a lactating adenoma. The mass was excised at 31 weeks gestation with no complications.
    Discussion: Lactating adenomas are common during pregnancy and need to be distinguished from breast cancer, a commonly diagnosed malignancy in pregnancy. They can be distinguished from carcinoma and other benign tumors like fibroadenoma under histopathologic examination. Rare cases of giant lactating adenomas with rapid postpartum enlargement that were managed by postpartum excision have been reported. However, a giant lactating adenoma with rapid antepartum enlargement, managed by excision in the third trimester of pregnancy, has not been reported.
    Conclusion: Excision of a large, rapidly enlarging lactating adenoma in the third trimester of pregnancy is a safe and feasible management option.
    Language English
    Publishing date 2016-01-25
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2210-2612
    ISSN 2210-2612
    DOI 10.1016/j.ijscr.2016.01.027
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  8. Article ; Online: Dosimetry and Toxicity Outcomes in Patients Treated with Hypofractionated Regional Nodal Irradiation for Breast Cancer: What is the Best Dose-Volume Limit to Minimize Risks of Radiation Pneumonitis?

    Schad, Michael D / Richman, Adam H / Diego, Emilia J / McAuliffe, Priscilla F / Johnson, Ronald R / Steiman, Jennifer / Vargo, John A / Beriwal, Sushil

    Practical radiation oncology

    2022  Volume 13, Issue 4, Page(s) 291–300

    Abstract: Purpose: Although published data have supported the use of hypofractionated regional nodal irradiation (HF-RNI) for breast cancer, limited dosimetric data exist to evaluate predictors of lung toxicity. The ongoing RT CHARM trial limits the percentage of ...

    Abstract Purpose: Although published data have supported the use of hypofractionated regional nodal irradiation (HF-RNI) for breast cancer, limited dosimetric data exist to evaluate predictors of lung toxicity. The ongoing RT CHARM trial limits the percentage of ipsilateral lung volume that receives ≥18 Gy to 35 to 40%. We assessed dosimetry, toxicity, and disease outcomes in patients with breast cancer treated with HF-RNI with a particular focus on pneumonitis.
    Methods and materials: We retrospectively reviewed all patients with breast cancer treated with HF-RNI (40-43 Gy in 15-16 fractions) after either lumpectomy or mastectomy at The University of Pittsburgh Medical Center from September 2018 to December 2021 to collect dosimetric and outcomes data. All post-radiation therapy chest computed tomography (CT) scans were manually reviewed for evidence of acute (≤6 months postradiation) or chronic (>6 months postradiation) pneumonitis.
    Results: One-hundred-ninety-one patients qualified with a median follow-up of 20.3 months (range, 5.1-42.2). Acute grade 1 (G1) pneumonitis was observed in 6.8% of the overall cohort (13 of 191 patients) and 39.4% of the patients (13 of 33) who received a chest CT ≤6 months postradiation therapy. Only 1 patient developed acute G2 pneumonitis. Chronic G1 pneumonitis was observed in 29.8% of the overall cohort (57 of 191 patients) and 77% of patients (57 of 74 patients) who received a chest CT >6 months postradiation therapy. No patients developed acute G3+ or chronic G2+ pneumonitis.
    Conclusions: Rates of symptomatic pneumonitis were low in this cohort of patients treated with HF-RNI, even with integration of HER2/neu-directed therapy, chemotherapy, hormone therapy, and internal mammary nodal irradiation. Lung V20Gy <26% appeared safe in this cohort to limit symptomatic pneumonitis, though this is not meant to represent the safe upper limit. Given the low event rate of symptomatic pneumonitis, data from larger cohorts will be needed to assess dosimetric predictors and the safe upper limit of lung dose.
    MeSH term(s) Humans ; Female ; Breast Neoplasms/radiotherapy ; Breast Neoplasms/surgery ; Radiation Pneumonitis/epidemiology ; Radiation Pneumonitis/etiology ; Radiation Pneumonitis/prevention & control ; Mastectomy ; Retrospective Studies ; Radiotherapy Dosage ; Pneumonia/etiology ; Pneumonia/prevention & control ; Pneumonia/surgery
    Language English
    Publishing date 2022-11-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2655748-4
    ISSN 1879-8519 ; 1879-8500
    ISSN (online) 1879-8519
    ISSN 1879-8500
    DOI 10.1016/j.prro.2022.10.007
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  9. Article ; Online: Is the Choosing Wisely Recommendation for Omission of Sentinel Lymph Node Biopsy Applicable for Invasive Lobular Carcinoma?

    Carleton, Neil / Oesterreich, Steffi / Marroquin, Oscar C / Diego, Emilia J / Tseng, George C / Lee, Adrian V / McAuliffe, Priscilla F

    Annals of surgical oncology

    2022  Volume 29, Issue 9, Page(s) 5379–5382

    MeSH term(s) Axilla/pathology ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Carcinoma, Ductal, Breast/pathology ; Carcinoma, Lobular/pathology ; Carcinoma, Lobular/surgery ; Female ; Humans ; Lymph Nodes/pathology ; Lymphatic Metastasis/pathology ; Sentinel Lymph Node/pathology ; Sentinel Lymph Node/surgery ; Sentinel Lymph Node Biopsy
    Language English
    Publishing date 2022-06-13
    Publishing country United States
    Document type Letter
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-022-12003-3
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  10. Article ; Online: Support of pregnancy and parental leave for trainees and practicing surgeons.

    Altieri, Maria S / Pryor, Aurora / Torres, Madeline B / Miller, Megan E / Möller, Mecker G / Diego, Emilia J / Reyna, Chantal

    American journal of surgery

    2022  Volume 224, Issue 6, Page(s) 1501–1503

    Language English
    Publishing date 2022-08-15
    Publishing country United States
    Document type Editorial
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2022.08.005
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