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  1. Article ; Online: Imaging Changes and Outcomes of Patients Undergoing Active Monitoring for Ductal Carcinoma In Situ: Seven-Year Follow-up Study.

    Nguyen, Derek L / Shelley Hwang, E / Ryser, Marc D / Grimm, Lars J

    Academic radiology

    2024  

    Abstract: Rationale and objectives: To determine the imaging changes and their associated positive predictive value (PPV) for invasive breast cancer in women undergoing active monitoring for ductal carcinoma in situ (DCIS).: Materials and methods: In this ... ...

    Abstract Rationale and objectives: To determine the imaging changes and their associated positive predictive value (PPV) for invasive breast cancer in women undergoing active monitoring for ductal carcinoma in situ (DCIS).
    Materials and methods: In this seven-year follow-up retrospective IRB-exempted cohort study, we reviewed patients diagnosed with DCIS who elected active monitoring between 2003 and 2022 at a single academic institution. Imaging characteristics, histopathology at initial diagnosis, and subsequent follow-up were recorded. Low-risk DCIS was defined as low or intermediate grade and hormone receptor (HR) positive (estrogen and/or progesterone receptor positive) disease diagnosed in women at least 40 years of age. Progression was defined as subsequent ipsilateral invasive breast cancer diagnosis.
    Results: There were 39 patients with a median age of 58.4 years (IQR: 51.1-69.6 years) and a median follow-up of 4.3 years (range: 0.6-16.4 years). Nearly two thirds of patients (64%, 25/39) had stable imaging (range: 0.6-16.4 years) and remained progression-free during active monitoring. Among the remaining 14 patients (36%), there were 24 imaging findings which prompted 22 subsequent core needle biopsies (range: 1-3 biopsies per patient) and two surgical biopsies. The PPV of invasive cancer was 29% (7/24) overall and 38% (3/8) for masses, 33% (3/9) for calcifications, 17% (1/6) for non-mass enhancement, and 0% (0/1) for architectural distortion.
    Conclusion: Of the radiographic changes prompting an additional biopsy, development of a new mass (38%) and new calcifications (33%) had the highest PPV for invasive progression. Close imaging follow-up should be a critical component for patients undergoing monitoring for DCIS.
    Language English
    Publishing date 2024-01-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1355509-1
    ISSN 1878-4046 ; 1076-6332
    ISSN (online) 1878-4046
    ISSN 1076-6332
    DOI 10.1016/j.acra.2023.12.021
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    Zs.A 4594: Show issues Location:
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  2. Article ; Online: What Can Molecular Diagnostics Add to Locoregional Treatment Recommendations for DCIS?

    Shelley Hwang, E / Thompson, Alastair

    Journal of the National Cancer Institute

    2017  Volume 109, Issue 4

    MeSH term(s) Biomarkers, Tumor/genetics ; Breast Neoplasms/pathology ; Breast Neoplasms/radiotherapy ; Breast Neoplasms/surgery ; Carcinoma, Ductal, Breast/pathology ; Carcinoma, Ductal, Breast/radiotherapy ; Carcinoma, Ductal, Breast/surgery ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Carcinoma, Intraductal, Noninfiltrating/radiotherapy ; Carcinoma, Intraductal, Noninfiltrating/surgery ; Combined Modality Therapy ; Female ; Humans ; Incidence ; Mastectomy, Segmental ; Neoplasm Recurrence, Local/diagnosis ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/genetics ; Prognosis ; Radiotherapy, Conformal ; Transcriptome
    Chemical Substances Biomarkers, Tumor
    Language English
    Publishing date 2017-04-04
    Publishing country United States
    Document type Editorial
    ZDB-ID 2992-0
    ISSN 1460-2105 ; 0027-8874 ; 0198-0157
    ISSN (online) 1460-2105
    ISSN 0027-8874 ; 0198-0157
    DOI 10.1093/jnci/djw270
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  3. Article ; Online: Active Surveillance for DCIS: The Importance of Selection Criteria and Monitoring.

    Grimm, Lars J / Shelley Hwang, E

    Annals of surgical oncology

    2016  Volume 23, Issue 13, Page(s) 4134–4136

    Language English
    Publishing date 2016-10-04
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-016-5596-2
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  4. Article: Derivation of a nuclear heterogeneity image index to grade DCIS.

    Hayward, Mary-Kate / Louise Jones, J / Hall, Allison / King, Lorraine / Ironside, Alastair J / Nelson, Andrew C / Shelley Hwang, E / Weaver, Valerie M

    Computational and structural biotechnology journal

    2020  Volume 18, Page(s) 4063–4070

    Abstract: Abnormalities in cell nuclear morphology are a hallmark of cancer. Histological assessment of cell nuclear morphology is frequently used by pathologists to grade ductal carcinoma in situ (DCIS). Objective methods that allow standardization and ... ...

    Abstract Abnormalities in cell nuclear morphology are a hallmark of cancer. Histological assessment of cell nuclear morphology is frequently used by pathologists to grade ductal carcinoma in situ (DCIS). Objective methods that allow standardization and reproducibility of cell nuclear morphology assessment have potential to improve the criteria needed to predict DCIS progression and recurrence. Aggressive cancers are highly heterogeneous. We asked whether cell nuclear morphology heterogeneity could be incorporated into a metric to classify DCIS. We developed a nuclear heterogeneity image index to objectively, and quantitatively grade DCIS. A whole-tissue cell nuclear morphological analysis, that classified tumors by the worst ten percent in a duct-by-duct manner, identified nuclear size ranges associated with each DCIS grade. Digital image analysis further revealed increasing heterogeneity within ducts or between ducts in tissues of worsening DCIS grade. The findings illustrate how digital image analysis comprises a supplemental tool for pathologists to objectively classify DCIS and in the future, may provide a method to predict patient outcome through analysis of nuclear heterogeneity.
    Language English
    Publishing date 2020-12-03
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2694435-2
    ISSN 2001-0370
    ISSN 2001-0370
    DOI 10.1016/j.csbj.2020.11.040
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  5. Article ; Online: The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment.

    Obeng-Gyasi, Samilia / Tolnitch, Lisa / Greenup, Rachel A / Shelley Hwang, E

    Annals of surgical oncology

    2016  Volume 23, Issue 10, Page(s) 3412–3417

    Abstract: Background: The Affordable Care Act (ACA) was instated on 23 March 2010 to improve healthcare quality, reduce costs, and increase access. The Pretty in Pink Foundation (PIPF), a non-profit 501(C)(3) organization in North Carolina, provides financial ... ...

    Abstract Background: The Affordable Care Act (ACA) was instated on 23 March 2010 to improve healthcare quality, reduce costs, and increase access. The Pretty in Pink Foundation (PIPF), a non-profit 501(C)(3) organization in North Carolina, provides financial assistance and in-kind support to individuals seeking help with breast cancer care. The objective of this study was to determine whether sociodemographic variables and treatment services varied among PIPF recipients since enactment of the ACA.
    Methods: North Carolinians who received financial assistance from the PIPF between 1 January 2013 and 31 December 2014 were included in the study, and the cohort was divided into two groups based on receipt of assistance before or after the enactment of the ACA. Descriptive statistics were tabulated as frequencies. Comparative univariate analysis between both groups was conducted using the χ (2) and Mann-Whitney U tests. All tests were two-sided and a p value <0.05 was considered statistically significant. All analyses were conducted using Stata.
    Results: Overall, 1016 individuals fulfilled the inclusion criteria, and the median age of the cohort was 49 years (interquartile range 45-55). The ACA groups did not differ significantly by age, race, and sex; however, the groups varied with respect to income, employment, and clinical stage. In addition, the groups differed on the types of services for which they received financial assistance, but no difference was observed between groups with respect to insurance status.
    Conclusion: Since the enactment of the health insurance market component of the ACA, there has been a reduction in subjects receiving assistance from the PIPF; however, no change in their insurance status has been observed.
    MeSH term(s) Adult ; Breast Neoplasms/economics ; Breast Neoplasms/pathology ; Breast Neoplasms/therapy ; Employment/statistics & numerical data ; Female ; Financial Support ; Humans ; Income/statistics & numerical data ; Insurance, Health/statistics & numerical data ; Middle Aged ; Neoplasm Staging ; North Carolina ; Organizations, Nonprofit/statistics & numerical data ; Organizations, Nonprofit/trends ; Patient Protection and Affordable Care Act
    Language English
    Publishing date 2016-07-13
    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/s10434-016-5311-3
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    Zs.A 4042: Show issues Location:
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  6. Article ; Online: Surgical Management of the Axilla in Elderly Women With Node-Positive Breast Cancer.

    Marks, Caitlin E / Ren, Yi / Rosenberger, Laura H / Thomas, Samantha M / Greenup, Rachel A / Fayanju, Oluwadamilola M / McDuff, Susan / Kimmick, Gretchen / Shelley Hwang, E / Plichta, Jennifer K

    The Journal of surgical research

    2020  Volume 254, Page(s) 275–285

    Abstract: Background: Elderly women with clinically node-positive (cN+) breast cancer (BC) often have comorbidities that limit life expectancy and complicate treatment. We sought to determine whether the number of lymph nodes (LNs) retrieved among older women ... ...

    Abstract Background: Elderly women with clinically node-positive (cN+) breast cancer (BC) often have comorbidities that limit life expectancy and complicate treatment. We sought to determine whether the number of lymph nodes (LNs) retrieved among older women with node-positive BC was associated with overall survival (OS).
    Methods: Using the National Cancer Database (2010-2015), women 70-90 y with cN + BC and ≥1 LNs removed were categorized by treatment sequence: upfront surgery or neoadjuvant chemotherapy (NAC). Multivariable Cox proportional hazards models with restricted cubic splines characterized the functional association of LN retrieval with OS; threshold values of LN retrieval were estimated. Cox proportional hazards models were used to estimate the association of LN retrieval groups with OS.
    Results: In the upfront surgery cohort, a nonlinear association was identified between LNs retrieved and OS. In the NAC cohort, no association was identified. For the upfront surgery cohort, the optimal threshold value of LN retrieval was 21 LNs (90% confidence interval 18-23). Based on this estimate, LN retrieval groups were created: <6, 6-11, 12-17, 18-23, and >23 LNs. After adjustment, retrieval of <12 LNs in the upfront surgery group was associated with a worse OS. No differences were observed in the NAC group.
    Conclusions: For elderly women receiving upfront surgery, there is no survival benefit to removing more than 12 LNs, and for those receiving NAC, there is no association between number of LNs removed and survival. In older women who present with cN + BC, aggressive surgery to remove more than 12 LNs may not be necessary.
    MeSH term(s) Aged ; Aged, 80 and over ; Axilla/surgery ; Breast Neoplasms/mortality ; Breast Neoplasms/surgery ; Cohort Studies ; Combined Modality Therapy ; Female ; Humans ; Lymph Node Excision ; United States/epidemiology
    Language English
    Publishing date 2020-05-29
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2020.04.036
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  7. Article: Author Correction: Cellphone enabled point-of-care assessment of breast tumor cytology and molecular HER2 expression from fine-needle aspirates.

    Joh, Daniel Y / Heggestad, Jacob T / Zhang, Shengwei / Anderson, Gray R / Bhattacharyya, Jayanta / Wardell, Suzanne E / Wall, Simone A / Cheng, Amy B / Albarghouthi, Faris / Liu, Jason / Oshima, Sachi / Hucknall, Angus M / Hyslop, Terry / Hall, Allison H S / Wood, Kris C / Shelley Hwang, E / Strickland, Kyle C / Wei, Qingshan / Chilkoti, Ashutosh

    NPJ breast cancer

    2021  Volume 7, Issue 1, Page(s) 126

    Language English
    Publishing date 2021-09-17
    Publishing country United States
    Document type Published Erratum
    ISSN 2374-4677
    ISSN 2374-4677
    DOI 10.1038/s41523-021-00335-4
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  8. Article: Cellphone enabled point-of-care assessment of breast tumor cytology and molecular HER2 expression from fine-needle aspirates.

    Joh, Daniel Y / Heggestad, Jacob T / Zhang, Shengwei / Anderson, Gray R / Bhattacharyya, Jayanta / Wardell, Suzanne E / Wall, Simone A / Cheng, Amy B / Albarghouthi, Faris / Liu, Jason / Oshima, Sachi / Hucknall, Angus M / Hyslop, Terry / Hall, Allison H S / Wood, Kris C / Shelley Hwang, E / Strickland, Kyle C / Wei, Qingshan / Chilkoti, Ashutosh

    NPJ breast cancer

    2021  Volume 7, Issue 1, Page(s) 85

    Abstract: Management of breast cancer in limited-resource settings is hindered by a lack of low-cost, logistically sustainable approaches toward molecular and cellular diagnostic pathology services that are needed to guide therapy. To address these limitations, we ...

    Abstract Management of breast cancer in limited-resource settings is hindered by a lack of low-cost, logistically sustainable approaches toward molecular and cellular diagnostic pathology services that are needed to guide therapy. To address these limitations, we have developed a multimodal cellphone-based platform-the EpiView-D4-that can evaluate both cellular morphology and molecular expression of clinically relevant biomarkers directly from fine-needle aspiration (FNA) of breast tissue specimens within 1 h. The EpiView-D4 is comprised of two components: (1) an immunodiagnostic chip built upon a "non-fouling" polymer brush-coating (the "D4") which quantifies expression of protein biomarkers directly from crude cell lysates, and (2) a custom cellphone-based optical microscope ("EpiView") designed for imaging cytology preparations and D4 assay readout. As a proof-of-concept, we used the EpiView-D4 for assessment of human epidermal growth factor receptor-2 (HER2) expression and validated the performance using cancer cell lines, animal models, and human tissue specimens. We found that FNA cytology specimens (prepared in less than 5 min with rapid staining kits) imaged by the EpiView-D4 were adequate for assessment of lesional cellularity and tumor content. We also found our device could reliably distinguish between HER2 expression levels across multiple different cell lines and animal xenografts. In a pilot study with human tissue (n = 19), we were able to accurately categorize HER2-negative and HER2-positve tumors from FNA specimens. Taken together, the EpiView-D4 offers a promising alternative to invasive-and often unavailable-pathology services and may enable the democratization of effective breast cancer management in limited-resource settings.
    Language English
    Publishing date 2021-07-02
    Publishing country United States
    Document type Journal Article
    ISSN 2374-4677
    ISSN 2374-4677
    DOI 10.1038/s41523-021-00290-0
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  9. Article ; Online: Patient Age and Tumor Subtype Predict the Extent of Axillary Surgery Among Breast Cancer Patients Eligible for the American College of Surgeons Oncology Group Trial Z0011.

    Ong, Cecilia T / Thomas, Samantha M / Blitzblau, Rachel C / Fayanju, Oluwadamilola M / Park, Tristen S / Plichta, Jennifer K / Rosenberger, Laura H / Hyslop, Terry / Shelley Hwang, E / Greenup, Rachel A

    Annals of surgical oncology

    2017  Volume 24, Issue 12, Page(s) 3559–3566

    Abstract: Background: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial established the safety of omitting axillary lymph node dissection (ALND) for early-stage breast cancer patients with limited nodal disease undergoing lumpectomy. We ... ...

    Abstract Background: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial established the safety of omitting axillary lymph node dissection (ALND) for early-stage breast cancer patients with limited nodal disease undergoing lumpectomy. We examined the extent of axillary surgery among women eligible for Z0011 based on patient age and tumor subtype.
    Methods: Patients with cT1-2, cN0 breast cancers and one or two positive nodes diagnosed from 2009 to 2014 and treated with lumpectomy were identified in the National Cancer Data Base. Sentinel lymph node biopsy (SLNB) was defined as the removal of 1-5 nodes and ALND as the removal of 10 nodes or more. Tumor subtype was categorized as luminal, human epidermal growth factor 2-positive (HER2+), or triple-negative. Logistic regression was used to estimate the odds of receiving SLNB alone versus ALND.
    Results: The inclusion criteria were met by 28,631 patients (21,029 SLNB-alone and 7602 ALND patients). Patients 70 years of age or older were more likely to undergo SLNB alone than ALND (27.0% vs 20.1%; p < 0.001). The radiation therapy use rate was 89.4% after SLNB alone and 89.7% after ALND. In the multivariate analysis, the uptake of Z0011 recommendations increased over time (2014 vs 2009: odds ratio [OR] 13.02; p < 0.001). Younger patients were less likely to undergo SLNB alone than older patients (age <40 vs ≥70: OR 0.59; p < 0.001). Patients with HER2+ (OR 0.89) or triple-negative disease (OR 0.79) (p < 0.001) were less likely to undergo SLNB alone than those with luminal subtypes.
    Conclusions: Among women potentially eligible for ACOSOG Z0011, the use of SLNB alone increased over time in all groups, but the extent of axillary surgery differed by patient age and tumor subtype.
    MeSH term(s) Adult ; Age Factors ; Aged ; Axilla ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Clinical Trials as Topic ; Databases, Factual ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Middle Aged ; Neoplasm Staging ; Patient Selection ; Sentinel Lymph Node Biopsy ; Surgeons
    Language English
    Publishing date 2017-09-06
    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/s10434-017-6075-0
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  10. Article ; Online: Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer.

    Gamble, Charlotte / Havrilesky, Laura J / Myers, Evan R / Chino, Junzo P / Hollenbeck, Scott / Plichta, Jennifer K / Kelly Marcom, P / Shelley Hwang, E / Kauff, Noah D / Greenup, Rachel A

    Annals of surgical oncology

    2017  Volume 24, Issue 11, Page(s) 3116–3123

    Abstract: Background: The appropriate management of breast cancer risk in BRCA mutation carriers following ovarian cancer diagnosis remains unclear. We sought to determine the survival benefit and cost effectiveness of risk-reducing mastectomy (RRM) among women ... ...

    Abstract Background: The appropriate management of breast cancer risk in BRCA mutation carriers following ovarian cancer diagnosis remains unclear. We sought to determine the survival benefit and cost effectiveness of risk-reducing mastectomy (RRM) among women with BRCA1/2 mutations following stage II-IV ovarian cancer.
    Design: We constructed a decision model from a third-party payer perspective to compare annual screening with magnetic resonance imaging (MRI) and mammography to annual screening followed by RRM with reconstruction following ovarian cancer diagnosis. Survival, overall costs, and cost effectiveness were determined by decade at diagnosis using 2015 US dollars. All inputs were obtained from the literature and public databases. Monte Carlo probabilistic sensitivity analysis was performed with a $100,000 willingness-to-pay threshold.
    Results: The incremental cost-effectiveness ratio (ICER) per year of life saved (YLS) for RRM increased with age and BRCA2 mutation status, with greater survival benefit demonstrated in younger patients with BRCA1 mutations. RRM delayed 5 years in 40-year-old BRCA1 mutation carriers was associated with 5 months of life gained (ICER $72,739/YLS), and in 60-year-old BRCA2 mutation carriers was associated with 0.8 months of life gained (ICER $334,906/YLS). In all scenarios, $/YLS and mastectomies per breast cancer prevented were lowest with RRM performed 5-10 years after ovarian cancer diagnosis.
    Conclusion: For most BRCA1/2 mutation carriers following ovarian cancer diagnosis, RRM performed within 5 years is not cost effective when compared with breast cancer screening. Imaging surveillance should be advocated during the first several years after ovarian cancer diagnosis, after which point the benefits of RRM can be considered based on patient age and BRCA mutation status.
    MeSH term(s) Adult ; Aged ; BRCA1 Protein/genetics ; BRCA2 Protein/genetics ; Breast Neoplasms/diagnosis ; Breast Neoplasms/economics ; Breast Neoplasms/genetics ; Breast Neoplasms/surgery ; Cost-Benefit Analysis ; Early Detection of Cancer/economics ; Female ; Follow-Up Studies ; Heterozygote ; Humans ; Mastectomy/economics ; Middle Aged ; Monte Carlo Method ; Mutation ; Ovarian Neoplasms/diagnosis ; Ovarian Neoplasms/economics ; Ovarian Neoplasms/genetics ; Ovarian Neoplasms/surgery ; Prognosis ; Quality-Adjusted Life Years ; Risk Reduction Behavior ; Survival Rate
    Chemical Substances BRCA1 Protein ; BRCA1 protein, human ; BRCA2 Protein ; BRCA2 protein, human
    Language English
    Publishing date 2017-07-11
    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/s10434-017-5995-z
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