Monica Morrow

Cornell University, Итак, New York, United States

Are you Monica Morrow?

Claim your profile

Publications (347)3333.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: White adipose tissue inflammation (WATi) has been linked to the pathogenesis of obesity-related diseases including type 2 diabetes, cardiovascular disease and cancer. In addition to the obese, a substantial number of normal and overweight individuals harbor WATi, putting them at increased risk for disease. We report the first technique that has the potential to non-invasively detect WATi. Here we used Raman spectroscopy to detect WATi with excellent accuracy in both murine and human tissues. This is a potentially significant advance over current histopathological techniques for the detection of WATi which rely on tissue excision and thus are not practical for assessing disease risk in the absence of other identifying factors . Importantly, we show that non-invasive Raman spectroscopy can diagnose WATi in mice and probe adipose in a human volunteer. Taken together, these results demonstrate the potential of Raman spectroscopy to provide objective risk assessment for future cardiometabolic complications in both normal weight and overweight/obese individuals.
    No preview · Article · Jan 2016 · Analytical Chemistry
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Obesity, insulin resistance, and elevated levels of circulating proinflammatory mediators are associated with poorer prognosis in early-stage breast cancer. To investigate whether white adipose tissue (WAT) inflammation represents a potential unifying mechanism, we examined the relationship between breast WAT inflammation and the metabolic syndrome and its prognostic importance. Experimental design: WAT inflammation was defined by the presence of dead/dying adipocytes surrounded by macrophages forming crown-like structures of the breast (CLS-B). Two independent groups were examined in cross-sectional (Cohort 1) and retrospective (Cohort 2) studies. Cohort 1 included 100 women undergoing mastectomy for breast cancer risk reduction (n=10) or treatment (n=90). Metabolic syndrome-associated circulating factors were compared by CLS-B status. The association between CLS-B and the metabolic syndrome was validated in Cohort 2 which included 127 women who developed metastatic breast cancer. Distant recurrence free survival (dRFS) was compared by CLS-B status. Results: In Cohorts 1 and 2, breast WAT inflammation was detected in 52/100 (52%) and 52/127 (41%) patients, respectively. Patients with breast WAT inflammation had elevated insulin, glucose, leptin, triglycerides, C-reactive protein, and interleukin-6; and lower HDL cholesterol and adiponectin (P<0.05) in Cohort 1. In Cohort 2, breast WAT inflammation was associated with hyperlipidemia, hypertension, and diabetes (P<0.05). Compared to patients without breast WAT inflammation, the adjusted hazard ratio for dRFS was 1.83 (95% CI, 1.07 to 3.13) for patients with inflammation. Conclusions: WAT inflammation, a clinically occult process, helps to explain the relationship between metabolic syndrome and worse breast cancer prognosis.
    No preview · Article · Dec 2015 · Clinical Cancer Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Reoperative sentinel lymph node biopsy (SLNB) is feasible in patients with local recurrence (LR) of invasive breast cancer but it remains unclear if this procedure affects either treatment or outcome. In this study, we ask whether axillary restaging (vs. none) at the time of LR affects the rate of subsequent events: axillary failure (AF), non-axillary recurrence (NAR), distant metastasis, or death. Methods: We queried our institutional database to identify patients treated surgically for invasive breast cancer with a negative SLNB (1997-2000) who developed ipsilateral breast or chest wall recurrence as a first event. We excluded those with gross nodal disease at the time of LR. The cumulative incidence of subsequent events was estimated using competing risks methodology. Results: Of 1527 patients with negative SLN at initial surgery, 83 had an ipsilateral breast (79) or chest wall recurrence (4) with clinically negative regional nodes; 47 (57 %) were treated with and 36 (43 %) without axillary surgery. Primary tumor characteristics were similar between groups, although time to LR was shorter in the no axillary surgery group (median 3.4 vs. 6.5 years; p < 0.05). All patients in the axillary surgery group and 94 % of patients in the no axillary surgery group had surgical excision of their LR, and the use of subsequent radiation and systemic therapy was similar between groups. At a median follow-up of 4.2 years from the time of LR, the rates of AF, NAR, distant metastasis and death were low and did not differ between groups. Conclusions: Among breast cancer patients with LR and clinically negative nodes, our results question the value of axillary restaging but invite confirmation in larger patient cohorts. Since randomized trials support the value of systemic therapy for all patients with invasive LR, reoperative SLNB, although feasible, may not be necessary.
    No preview · Article · Dec 2015 · Annals of Surgical Oncology
  • Monica Morrow · Steven J. Katz

    No preview · Article · Dec 2015 · JNCI Journal of the National Cancer Institute
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: American College of Surgeons Oncology Group (ACOSOG) Z0011 defined clinical node negativity by physical examination alone. Although axillary ultrasound with biopsy has a positive predictive value for lymph node (LN) metastases approaching 100 %, it may not appropriately identify clinically node-negative women with ≥3 positive LNs who require axillary lymph node dissection (ALND). We sought to identify the total number of positive LNs in women presenting with cT1-2N0 breast carcinoma with a positive preoperative LN biopsy to evaluate the potential for overtreatment when ALND is performed on the basis of a positive needle biopsy in patients who otherwise meet ACOSOG Z0011 eligibility criteria. Methods: Patients with cT1-2N0 breast cancer by physical examination with a positive preoperative LN biopsy were identified from a prospective institutional database. Clinicopathologic characteristics and axillary imaging results were compared between women with 1 to 2 total positive LNs and ≥3 total positive LNs. Results: Between May 2006 and December 2013, a total of 141 women with cT1-2N0 breast cancer had abnormal axillary imaging and a preoperative positive LN biopsy (median patient age 51 years, median tumor size 2.4 cm, 86 % ductal histology, 79 % estrogen receptor positive). Sixty-six women (47 %) had 1 to 2 total positive LNs, and 75 (53 %) had ≥3 total positive LNs. Women with ≥3 total positive LNs had larger tumors (2.4 vs. 2.2 cm, p = 0.03), fewer tumors with ductal histology (79 vs. 94 %, p = 0.01), more lymphovascular invasion (80 vs. 61 %, p = 0.01), and higher median body mass index (29.2 vs. 27.1 kg/m(2), p = 0.04). Having >1 abnormal LN on axillary imaging was significantly associated with having ≥3 total positive LNs at final pathology (68 vs. 43 %, p = 0.003). Conclusions: Axillary imaging with preoperative LN biopsy does not accurately discriminate low- versus high-volume nodal disease in clinically node-negative patients.
    No preview · Article · Nov 2015 · Annals of Surgical Oncology
  • A. Sabolch · K.A. Griffith · S. Katz · M. Morrow · R. Jagsi

    No preview · Article · Nov 2015 · International journal of radiation oncology, biology, physics

  • No preview · Article · Nov 2015 · International journal of radiation oncology, biology, physics
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: American College of Surgeons Oncology Group (ACOSOG) Z0011 results support the omission of axillary lymph node dissection (ALND) in women with less than 3 positive sentinel lymph nodes (SLNs) undergoing breast-conserving surgery (BCS) and radiation therapy. We sought to determine if abnormal axillary imaging is predictive of the need for ALND in this population. Study design: Patients with cT1-2N0 breast cancer by physical examination undergoing BCS were managed according to Z0011 criteria independent of axillary imaging. Patient characteristics and rates of ALND were compared among those with and without abnormal lymph nodes (LNs) detected by mammogram, ultrasound (US), or MRI. All available axillary imaging was reviewed by 1 breast radiologist. Results: Between August 2010 and December 2013, 3,253 breast cancer patients were treated with BCS and SLN biopsy; 425 patients met Z0011 criteria (cT1-2N0) and had nodal metastasis on SLN biopsy. Clinicopathologic features were median patient age, 58 years; median tumor size, 1.8 cm; 85% ductal histology; and 89% estrogen receptor positive. All women had a mammogram, 242 had axillary US, 172 had MRI. Abnormal LNs were seen on 7%, 25%, and 30% of mammograms, US, and MRIs, respectively. Although abnormal LNs on mammogram or US were associated with a significant increase in ALND and a non-significant trend was seen with MRI, 68% to 73% of women with abnormal axillary imaging did not require ALND. Conclusions: Among clinically node-negative patients with abnormal axillary imaging, 71% did not meet criteria for ALND and were spared further surgical morbidity. Abnormal nodes on US, MRI, or mammogram in clinically node-negative patients are not reliable indicators of the need for ALND.
    No preview · Article · Nov 2015 · Journal of the American College of Surgeons
  • Tari A. King · Melissa Pilewskie · Monica Morrow
    [Show abstract] [Hide abstract]
    ABSTRACT: The recognition that breast cancer is a group of genetically distinct diseases with differing responses to treatment and varying patterns of both local and systemic failure has led to many questions regarding optimal therapy for those considered to be high risk. Young patients, patients with triple-negative breast cancer (TNBC), and those who harbor a deleterious mutation in BRCA1 or BRCA2 are frequently considered to be at highest risk of local failure, leading to speculation that more-aggressive surgical treatment is warranted in these patients. For both age and the triple-negative subtype, it appears that the intrinsic biology which imparts inferior outcomes is not overcome with mastectomy; therefore, a recommendation for more extensive surgical therapy among these higher-risk groups is not warranted. For those at inherited risk, a more-aggressive surgical approach may be preferable, however; patient age, ER status, stage of the index lesion, and individual patient preferences should all be considered in the surgical decision-making process.
    No preview · Article · Oct 2015 · Breast (Edinburgh, Scotland)
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The increased breast cancer risk conferred by a diagnosis of lobular carcinoma in situ (LCIS) is poorly understood. Here, we review our 29-year longitudinal experience with LCIS to evaluate factors associated with breast cancer risk. Patients and methods: Patients participating in surveillance after an LCIS diagnosis are observed in a prospectively maintained database. Comparisons were made among women choosing surveillance, with or without chemoprevention, and those undergoing bilateral prophylactic mastectomies between 1980 and 2009. Results: One thousand sixty patients with LCIS without concurrent breast cancer were identified. Median age at LCIS diagnosis was 50 years (range, 27 to 83 years). Fifty-six patients (5%) underwent bilateral prophylactic mastectomy; 1,004 chose surveillance with (n = 173) or without (n = 831) chemoprevention. At a median follow-up of 81 months (range, 6 to 368 months), 150 patients developed 168 breast cancers (63% ipsilateral, 25% contralateral, 12% bilateral), with no dominant histology (ductal carcinoma in situ, 35%; infiltrating ductal carcinoma, 29%; infiltrating lobular carcinoma, 27%; other, 9%). Breast cancer incidence was significantly reduced in women taking chemoprevention (10-year cumulative risk: 7% with chemoprevention; 21% with no chemoprevention; P < .001). In multivariable analysis, chemoprevention was the only clinical factor associated with breast cancer risk (hazard ratio, 0.27; 95% CI, 0.15 to 0.50). In a subgroup nested case-control analysis, volume of disease, which was defined as the ratio of slides with LCIS to total number of slides reviewed, was also associated with breast cancer development (P = .008). Conclusion: We observed a 2% annual incidence of breast cancer among women with LCIS. Common clinical factors used for risk prediction, including age and family history, were not associated with breast cancer risk. The lower breast cancer incidence in women opting for chemoprevention highlights the potential for risk reduction in this population.
    No preview · Article · Sep 2015 · Journal of Clinical Oncology

  • No preview · Article · Sep 2015 · Journal of Clinical Oncology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Our goal was to investigate, in a large population of women with ductal carcinoma in situ (DCIS) and long follow-up, the relationship between margin width and recurrence, controlling for other characteristics. Background: Although DCIS has minimal mortality, recurrence rates after breast-conserving surgery are significant, and half are invasive. Positive margins are associated with increased risk of local recurrence, but there is no consensus regarding optimal negative margin width. Methods: We retrospectively reviewed a prospective database of DCIS patients undergoing breast-conserving surgery from 1978 to 2010. Univariate and Cox proportional hazard models were used to investigate the association between margin width and recurrence. Results: In this review, 2996 cases were identified, of which 363 recurred. Median follow-up for women without recurrence was 75 months (range 0-30 years); 732 were studied for ≥10 years. Controlling for age, family history, presentation, nuclear grade, number of excisions, radiotherapy (RT), endocrine therapy, and year of surgery, margin width was significantly associated with recurrence in the entire population. Larger negative margins were associated with a lower hazard ratio compared with positive margins. An interaction between RT and margin width was significant (P < 0.03); the association of recurrence with margin width was significant in those without RT (P < 0.0001), but not in those with RT (P = 0.95). Conclusions: In women not receiving RT, wider margins are significantly associated with a lower rate of recurrence. Obtaining wider negative margins may be important in reducing the risk of recurrence in women who choose not to undergo RT and may not be necessary in those who receive RT.
    No preview · Article · Sep 2015 · Annals of surgery
  • A T Manning · C Wood · A Eaton · M Stempel · D Capko · A Pusic · M Morrow · V Sacchini
    [Show abstract] [Hide abstract]
    ABSTRACT: Nipple-sparing mastectomy (NSM) is associated with improved cosmesis and is being performed increasingly. Its role in BRCA mutation carriers has not been well described. This was a study of the indications for, and outcomes of, NSM in BRCA mutation carriers. BRCA mutation carriers who underwent NSM were identified. Details of patient demographics, surgical procedures, complications, and relevant disease stage and follow-up were recorded. A total of 177 NSMs were performed in 89 BRCA mutation carriers between September 2005 and December 2013. Twenty-six patients of median age 41 years had NSM for early-stage breast cancer and a contralateral prophylactic mastectomy. Mean tumour size was 1·4 (range 0·1-3·5) cm. Sixty-three patients of median age 39 years had prophylactic NSM, eight of whom had an incidental diagnosis of ductal carcinoma in situ. There were no local or regional recurrences in the 26 patients with breast cancer at a median follow-up of 28 (i.q.r. 15-43) months. There were no newly diagnosed breast cancers in the 63 patients undergoing prophylactic NSM at a median follow-up of 26 (11-42) months. All patients had immediate breast reconstruction. Five patients (6 per cent) required subsequent excision of the nipple-areola complex for oncological or other reasons. Skin desquamation occurred in 68 (38·4 per cent) of the 177 breasts, and most resolved without intervention. Debridement was required in 13 (7·3 per cent) of the 177 breasts, and tissue-expander or implant removal was necessary in six instances (3·4 per cent). NSM is an acceptable choice for patients with BRCA mutations, with no evidence of compromise to oncological safety at short-term follow-up. Complication rates were acceptable, and subsequent excision of the nipple-areola complex was rarely required. © 2015 BJS Society Ltd. Published by John Wiley & Sons Ltd.
    No preview · Article · Aug 2015 · British Journal of Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Methods: In this Institutional Review Board approved retrospective study, our Hospital Information System was screened for ILC patients who underwent PET/CT in 2006-2013 prior to systemic or radiation therapy. Initial stage was determined from exam, mammography, ultrasound, magnetic resonance and/or surgery. PET/CT was performed to identify unsuspected distant metastases. A sequential cohort of stage III IDC patients was evaluated for comparison. Upstaging rates were compared using Pearson chi square test. Results: 146 ILC patients fulfilled criteria. PET/CT revealed unsuspected distant metastases in 12 (8%): 0/8 initial stage I, 2/50 (4%) stage II, and 10/88 (11%) stage III. All patients upstaged to IV by PET/CT were confirmed by biopsy. 3/12 upstaged patients were upstaged only by the CT component of the PET/CT, as metastases were non-(18)F-FDG -avid. In the comparison stage III IDC cohort, 22% (20/89) of patients were upstaged to IV by PET/CT. All 20 demonstrated (18)F-FDG -avid metastases. The relative risk of PET/CT revealing unsuspected distant metastases in stage III IDC patients was 1.98 times (95% CI 0.98-3.98) that of stage III ILC patients (P = .049). For (18)F-FDG -avid metastases, the relative risk of PET/CT revealing unsuspected (18)F-FDG -avid distant metastases in stage III IDC patients was 2.82 times (95% CI 1.26-6.34) that of stage III ILC patients (P = .007) CONCLUSION: (18)F-FDG PET/CT was more likely to reveal unsuspected distant metastases in stage III IDC patients than in stage III ILC patients. In addition, some ILC patients were upstaged by non-(18)F-FDG -avid lesions visible only by the CT component. Overall, PET/CT may have lower impact on systemic staging of ILC patients than IDC patients.
    No preview · Article · Aug 2015 · Journal of Nuclear Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bilateral breast cancer (BBC) may present as synchronous (SBC) or metachronous breast cancer (MBC). Optimal surgical management of BBC patients is not well-defined. In this study, we report on histopathology, treatment, and outcomes in BBC patients. Upon Institutional Review Board approval, we identified BBC patients diagnosed and treated for invasive breast cancer between 1999 and 2007. Retrospective chart review for demographics, histopathology, treatment, and outcomes was performed, and factors associated with BCS choice were collected. Contraindication to BCS was defined as any of the following one-breast findings: multicentric disease, tumor considered too large for BCS, and a patient without a nominal breast size for acceptable cosmetic results. McNemar's test for matched pairs (binary variables) or the paired t test (continuous variables) were used to examine if a pathologic characteristic differed within a cancer pair. Kaplan-Meier methods estimated overall survival (OS). A total of 203 BBC patients (119 SBC, 84 MBC) comprised our study group. Histopathologic characteristics of the first and second cancers diagnosed in both the SBC and MBC patients were very similar in histologic type and molecular profiles. Overall, 57 % of MBC patients underwent breast-conserving surgery (BCS) at initial diagnosis versus 34 % of patients with SBC. BCS contraindications were similar in both groups: 16 (34 %) MBC patients and 28 (36 %) SBC patients. Kaplan-Meier OS estimates at 5 and 10 years were 86 and 78 % for MBC, and 87 and 77 % for SBC patients, respectively. OS was excellent for both the MBC and SBC groups. Contraindications to BCS did not differ between groups. However, patients with SBC were less likely to undergo BCS compared with patients with MBC at the time of initial diagnosis.
    No preview · Article · Aug 2015 · Annals of Surgical Oncology
  • Monica Morrow
    [Show abstract] [Hide abstract]
    ABSTRACT: Recognition of differing risks of locoregional recurrence (LRR) in breast cancer patients based on estrogen receptor, progesterone receptor, and HER2 status, coupled with a reduction in LRR in patients receiving adjuvant systemic therapy, offers the opportunity to tailor surgical treatment and reduce the morbidity of therapy. New guidelines for margins in breast-conserving therapy of tumor not touching ink and avoidance of axillary dissection in sentinel node positive patients undergoing breast-conserving therapy are examples of this approach which have entered practice. Increased use of neoadjuvant therapy offers the opportunity to identify which patients are responsive to chemotherapy prior to surgery, potentially allowing further tailoring of treatment, and ongoing clinical trials will address the question of the extent of axillary surgery and radiotherapy after neoadjuvant therapy in patients with and without pathologic complete response. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Aug 2015 · Breast (Edinburgh, Scotland)
  • [Show abstract] [Hide abstract]
    ABSTRACT: The relative contribution of biologic subtype to locoregional recurrence (LRR) in patients treated with neoadjuvant chemotherapy (NAC), mastectomy, and postmastectomy radiotherapy (PMRT) is not clearly defined. 233 patients with stages 2 and 3 breast cancer who received NAC, mastectomy, and PMRT between 2000 and 2009 were included: 53 % (n = 123) had HR+ (ER or PR+/HER2-), 23 % (n = 53) had HER2+ (HER2+/HR+ or HR-), and 24 % (n = 57) had triple-negative (TN) disease (HR-/HER2-). The 5-year LRR rates were estimated by Kaplan-Meier methods. Cox regression analysis was performed to evaluate covariates associated with LRR. The median follow-up period was 62 months. A pathologic complete response (pCR) was seen in 14 % of the patients. The 5-year LRR rate was 8 % for the entire cohort. The LRR rate was 0 % for the patients with a pCR versus 9 % for the patients without a pCR (p = 0.05). TN disease [Hazard ratio (HR) 4.4; p = 0.003] and pathologic node positivity (HR 9.8; p = 0.03) were associated with LRR. Patients with TN disease had a higher LRR rate than patients with HER2+ or HR+ disease (20 vs. 6 and 4 %; p = 0.005). Among patients without a pCR, TN subtype was associated with increased LRR risk (26 versus 7 % HER+ and 4 % HR+; p < 0.001). Patients with TN breast cancer had the highest LRR rate after NAC, mastectomy and PMRT. Whereas no LRR was observed among TN patients with a pCR, TN patients with residual disease had a significantly higher LRR risk. Patients with HR+ and HER2+ breast cancer had favorable LRR rates regardless of NAC response, likely due to receipt of adjuvant systemic targeted therapies.
    No preview · Article · Aug 2015 · Annals of Surgical Oncology
  • Monica Morrow
    [Show abstract] [Hide abstract]
    ABSTRACT: Local control has traditionally been considered a function of disease burden. Local control is now known to differ among biologic subtypes of breast cancer and is greatly improved with the use of systemic therapy. This offers opportunities for decreasing the morbidity of treatment and individualizing local therapy. The use of smaller margins in breast-conserving surgery and elimination of axillary dissection for some node-positive breast cancer patients are current examples of leveraging the benefits of systemic therapy to reduce surgery. Emerging evidence indicates that molecular profiling can identify patients at high and low risk for locoregional recurrence after surgery in a more accurate way than tumor burden, potentially allowing individualization of the use of postmastectomy and comprehensive node field irradiation. Future clinical trials should incorporate both disease burden and molecular profiling when examining treatment strategies.
    No preview · Article · Jul 2015 · Annals of Surgical Oncology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Randomized trials of radiation after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) found substantial rates of recurrence, with half of the recurrences being invasive. Decreasing local recurrence rates for invasive breast carcinoma have been observed and are largely attributed to improvements in systemic therapy. In this study, we examine recurrence rates after BCS for DCIS over 3 decades at one institution. We retrospectively reviewed a prospectively maintained database of DCIS patients undergoing BCS from 1978 to 2010. Cox proportional hazard models were used to investigate the association between the treatment period and recurrence, controlling for other variables. Overall, 363 (12 %) recurrences among 2996 cases were observed. Median follow-up for patients without recurrence was 75 months (range 0-30 years); 732 patients were followed for ≥10 years. The 5-year recurrence rate for the period 1978-1998 was 13.6 versus 6.6 % for the period 1999-2010 [hazard ratio (HR) 0.62, p < 0.0001]. Controlling for age, family history, presentation, nuclear grade, necrosis, number of excisions, margin status, radiation, and endocrine therapy, treatment period remained significantly associated with recurrence, with later years associated with a lower HR (0.74, p = 0.02) compared to earlier. After stratification by radiation use, association of recurrence with treatment period persisted in those treated without radiation (HR 0.62, p = 0.003). Recurrence rates for DCIS have fallen over time, with increases in screen detection, negative margins, and use of adjuvant therapies only partially explaining this decrease. The unexplained decline persists in women not receiving radiation, suggesting it is not due to changes in radiation efficacy but may be due to improvements in radiologic detection and pathologic assessment.
    No preview · Article · Jul 2015 · Annals of Surgical Oncology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Multiple recent reports have documented significant variability of reoperation rates after initial lumpectomy for breast cancer. To address this issue, a multidisciplinary consensus conference was convened during the American Society of Breast Surgeons 2015 annual meeting. The conference mission statement was to "reduce the national reoperation rate in patients undergoing breast conserving surgery for cancer, without increasing mastectomy rates or adversely affecting cosmetic outcome, thereby improving value of care." The goal was to develop a toolbox of recommendations to reduce the variability of reoperation rates and improve cosmetic outcomes. Conference participants included providers from multiple disciplines involved with breast cancer care, as well as a patient representative. Updated systematic reviews of the literature and invited presentations were sent to participants in advance. After topic presentations, voting occurred for choice of tools, level of evidence, and strength of recommendation. The following tools were recommended with varied levels of evidence and strength of recommendation: compliance with the SSO-ASTRO Margin Guideline; needle biopsy for diagnosis before surgical excision of breast cancer; full-field digital diagnostic mammography with ultrasound as needed; use of oncoplastic techniques; image-guided lesion localization; specimen imaging for nonpalpable cancers; use of specialized techniques for intraoperative management, including excisional cavity shave biopsies and intraoperative pathology assessment; formal pre- and postoperative planning strategies; and patient-reported outcome measurement. A practical approach to performance improvement was used by the American Society of Breast Surgeons to create a toolbox of options to reduce lumpectomy reoperations and improve cosmetic outcomes.
    Full-text · Article · Jul 2015 · Annals of Surgical Oncology

Publication Stats

12k Citations
3,333.82 Total Impact Points

Institutions

  • 2012-2015
    • Cornell University
      • Department of Surgery
      Итак, New York, United States
  • 2008-2015
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Surgery
      • • Breast Service
      New York, New York, United States
  • 2010
    • University of Michigan
      Ann Arbor, Michigan, United States
    • Treatment Research Institute, Philadelphia PA
      Philadelphia, Pennsylvania, United States
  • 2009
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2004-2008
    • Fox Chase Cancer Center
      • • Department of Surgery
      • • Department of Radiation Oncology
      Filadelfia, Pennsylvania, United States
  • 2005
    • Duke University Medical Center
      • Department of Surgery
      Durham, NC, United States
  • 2000-2005
    • Northwestern Memorial Hospital
      • Department of Surgery
      Chicago, Illinois, United States
    • Northwestern University
      • • Department of Surgery
      • • Division of Gastroenterology and Hepatology
      Evanston, Illinois, United States
    • American College of Surgeons
      Chicago, Illinois, United States
  • 1995-2005
    • University of Illinois at Chicago
      • Department of Biopharmaceutical Sciences
      Chicago, Illinois, United States
  • 2002
    • Ann & Robert H. Lurie Children's Hospital of Chicago
      Chicago, Illinois, United States
  • 1999
    • Beth Israel Deaconess Medical Center
      • Department of Pathology
      Boston, Massachusetts, United States
    • American College of Radiology
      Philadelphia, Pennsylvania, United States
  • 1997
    • Northwest Hospital & Medical Center
      Seattle, Washington, United States