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Artikel ; Online: When Leaning In Becomes Unhealthy, Can We Fix It?

Diego, Emilia J / Carty, Sally E

2021 Band 156, Heft 10, Seite(n) 915–916

Mesh-Begriff(e)	Cardiopulmonary Resuscitation ; Humans
Sprache	Englisch
Erscheinungsdatum	2021-07-28
Erscheinungsland	United States
Dokumenttyp	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
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; 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 Band 27, Heft Suppl 3, Seite(n) 713–714

Mesh-Begriff(e)	Antiemetics ; Breast Neoplasms/surgery ; Enhanced Recovery After Surgery ; Female ; Humans ; Mastectomy/adverse effects ; Mastectomy/methods ; Nausea/etiology ; Pain, Postoperative/etiology ; Vomiting/etiology
Chemische Substanzen	Antiemetics
Sprache	Englisch
Erscheinungsdatum	2020-08-09
Erscheinungsland	United States
Dokumenttyp	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
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: 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

JCO clinical cancer informatics

2024 Band 8, Seite(n) e2300177

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

Abstract	Purpose: Natural language understanding (NLU) may be particularly well equipped for enhanced data capture from the electronic health record given its examination of both content-driven and context-driven extraction. Methods: We developed and applied a NLU model to examine rates of pathological node positivity (pN+) and rates of lymphedema to determine whether omission of routine axillary staging could be extended to younger patients with estrogen receptor-positive (ER+)/cN0 disease. Results: We found that rates of pN+ and arm lymphedema were similar between patients age 55-69 years and ≥70 years, with rates of lymphedema exceeding rates of pN+ for clinical stage T1c and smaller disease. Conclusion: Data from our NLU model suggest that omission of sentinel lymph node biopsy might be extended beyond Choosing Wisely recommendations, limited to those older than 70 years and 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.
Mesh-Begriff(e)	Humans ; Female ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Middle Aged ; Aged ; Neoplasm Staging ; Natural Language Processing ; Axilla ; Sentinel Lymph Node Biopsy/methods ; Electronic Health Records ; Lymphedema/etiology ; Lymphedema/epidemiology ; Lymphatic Metastasis ; Lymph Nodes/pathology ; Lymph Nodes/surgery
Sprache	Englisch
Erscheinungsdatum	2024-05-21
Erscheinungsland	United States
Dokumenttyp	Journal Article
ISSN	2473-4276
ISSN (online)	2473-4276
DOI	10.1200/CCI.23.00177
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: 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.
Sprache	Englisch
Erscheinungsdatum	2024-02-06
Erscheinungsland	United States
Dokumenttyp	Preprint
DOI	10.1101/2024.02.03.24302095
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; 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 Band 29, Heft 10, Seite(n) 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-Begriff(e)	Biopsy, Large-Core Needle ; Breast Neoplasms/epidemiology ; Breast Neoplasms/surgery ; Female ; Humans ; Margins of Excision ; Neoplasm Recurrence, Local/epidemiology ; Phyllodes Tumor/surgery ; Surgeons
Sprache	Englisch
Erscheinungsdatum	2022-07-18
Erscheinungsland	United States
Dokumenttyp	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
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; 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 Band 128, Heft 12, Seite(n) 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-Begriff(e)	Aged ; Axilla/pathology ; Breast Neoplasms/pathology ; Cost-Benefit Analysis ; Female ; Humans ; Lymph Node Excision ; Quality-Adjusted Life Years ; Sentinel Lymph Node Biopsy
Sprache	Englisch
Erscheinungsdatum	2022-04-07
Erscheinungsland	United States
Dokumenttyp	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
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; 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 Band 198, Heft 3, Seite(n) 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-Begriff(e)	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
Sprache	Englisch
Erscheinungsdatum	2023-02-20
Erscheinungsland	Netherlands
Dokumenttyp	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
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Case report of a large lactating adenoma with rapid antepartum enlargement.

Teng, Cindy Y / Diego, Emilia J

International journal of surgery case reports

2016 Band 20, Seite(n) 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.
Sprache	Englisch
Erscheinungsdatum	2016-01-25
Erscheinungsland	Netherlands
Dokumenttyp	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2016.01.027
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; 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 Band 13, Heft 4, Seite(n) 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-Begriff(e)	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
Sprache	Englisch
Erscheinungsdatum	2022-11-01
Erscheinungsland	United States
Dokumenttyp	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
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; 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 Band 29, Heft 9, Seite(n) 5379–5382

Mesh-Begriff(e)	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
Sprache	Englisch
Erscheinungsdatum	2022-06-13
Erscheinungsland	United States
Dokumenttyp	Letter
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-12003-3
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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