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von Waldenfels G, Beck MH, Semmler J, Gerber A, Hennigs A, Vochem R, Blohmer JU, Schmalfeldt B, Pietzner K, Sehouli J. Training in obstetrics and gynecology between reality and vision: results of a JAGO-NOGGO survey in 601 physicians (NOGGO-Monitor-12 trial). Arch Gynecol Obstet 2024:10.1007/s00404-024-07508-z. [PMID: 38625545 DOI: 10.1007/s00404-024-07508-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE The primary objective of this study was to establish a benchmark by collecting baseline data on surgical education in obstetrics and gynecology in Germany, including factual number of operations performed. MATERIALS AND METHODS A nationwide anonymous survey was conducted in Germany between January 2019 and July 2019 utilizing a specially designed questionnaire which addressed both residents and senior trainers. RESULTS A total of 601 participants completed the survey, comprising 305 trainees and 296 trainers. The trainees reported performing a median of 125 non-obstetric surgeries (IQR: 41-332) and 75 obstetric procedures (IQR: 27-168) independently. While most last-year residents managed to meet the targeted numbers for minor surgical procedures outlined in the logbook, they fell short of achieving the required numbers for major operations, such as hysterectomies or more complex laparoscopies. Although both trainees and trainers emphasized the significance of surgical training, the overall quality of the training was rated poorly, particularly by trainees. This was attributed to a high proportion of administrative tasks and a deficiency in teaching time within the operating theater. External fellowship and mentoring programs, as well as the implementation of regular, centralized reviews of residency training, were identified as potentially beneficial by both trainees and trainers. CONCLUSION The findings of this survey should serve as a wake-up call both within and outside of Germany, highlighting the importance of comprehensive and structured surgical training to enhance long-term patient care and increase satisfaction among obstetrics and gynecology trainees.
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Affiliation(s)
- Gabriel von Waldenfels
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
| | - Maximilian Heinz Beck
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany.
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Janina Semmler
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Obstetrics, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annika Gerber
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Fertility Doctors Berlin, Berlin, Germany
| | - André Hennigs
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Ruth Vochem
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- TFP Kinderwunsch Klagenfurt, Klagenfurt, Austria
| | - Jens-Uwe Blohmer
- Department of Gynecology, Breast Center, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Society of Gynecology and Obstetrics (DGGG), Berlin, Germany
| | - Klaus Pietzner
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Young Academy of Gynecologic Oncology (JAGO, ), Berlin, Germany
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Meyer-Schwickerath C, Weber C, Hornuss D, Rieg S, Hitzenbichler F, Hagel S, Ankert J, Hennigs A, Glossmann J, Jung N. Complexity of patients with or without infectious disease consultation in tertiary-care hospitals in Germany. Infection 2024; 52:577-582. [PMID: 38277092 PMCID: PMC10955003 DOI: 10.1007/s15010-023-02166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE Patients seen by infectious disease (ID) specialists are more complex compared to patients treated by other subspecialities according to Tonelli et al. (2018). However, larger studies on the complexity of patients related to the involvement of ID consultation services are missing. METHODS Data of patients being treated in 2015 and 2019 in four different German university hospitals was retrospectively collected. Data were collected from the hospitals' software system and included whether the patients received an ID consultation as well as patient clinical complexity level (PCCL), case mix index (CMI) and length of stay (LOS) as a measurement for the patients' complexity. Furthermore, a comparison of patients with distinct infectious diseases treated with or without an ID consultation was initiated. RESULTS In total, 215.915 patients were included in the study, 3% (n = 6311) of those were seen by an ID consultant. Patients receiving ID consultations had a significantly (p < 0.05) higher PCCL (median 4 vs. 0), CMI (median 3,8 vs. 1,1) and deviation of the expected mean LOS (median 7 days vs. 0 days) than patients in the control group. No differences among hospitals or between years were observed. Comparing patients with distinct infectious diseases treated with or without an ID consultation, the differences were confirmed throughout the groups. CONCLUSION Patients receiving ID consultations are highly complex, frequently need further treatment after discharge and have a high economic impact. Thus, ID specialists should be clinically trained in a broad spectrum of diseases and treating these complex patients should be sufficiently remunerated.
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Affiliation(s)
- C Meyer-Schwickerath
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - C Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - D Hornuss
- Faculty of Medicine, Department of Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg, Germany
| | - S Rieg
- Faculty of Medicine, Department of Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg, Germany
| | - F Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital of Regensburg, Regensburg, Germany
| | - S Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - J Ankert
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - A Hennigs
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Glossmann
- Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University of Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany.
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Togawa R, Pfob A, Büsch C, Fastner S, Gomez C, Goncalo M, Hennigs A, Killinger K, Nees J, Riedel F, Schäfgen B, Stieber A, Tozaki M, Heil J, Barr R, Golatta M. Intra- and Interobserver Reliability of Shear Wave Elastography in Breast Cancer Diagnosis. J Ultrasound Med 2024; 43:109-114. [PMID: 37772458 DOI: 10.1002/jum.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Shear wave elastography (SWE) is increasingly used in breast cancer diagnostics. However, large, prospective, multicenter data evaluating the reliability of SWE is missing. We evaluated the intra- and interobserver reliability of SWE in patients with breast lesions categorized as BIRADS 3 or 4. METHODS We used data of 1288 women at 12 institutions in 7 countries with breast lesions categorized as BIRADS 3 to 4 who underwent conventional B-mode ultrasound and SWE. 1243 (96.5%) women had three repetitive conventional B-mode ultrasounds as well as SWE measurements performed by a board-certified senior physician. 375 of 1288 (29.1%) women received an additional ultrasound examination with B-mode and SWE by a second physician. Intraclass correlation coefficients (ICC) were calculated to examine intra- and interobserver reliability. RESULTS ICC for intraobserver reliability showed an excellent correlation with ICC >0.9, while interobserver reliability was moderate with ICC of 0.7. There were no clinically significant differences in intraobserver reliability when SWE was performed in lesions categorized as BI-RADS 3 or 4 as well as in histopathologically benign or malignant lesions. CONCLUSION Reliability of additional SWE was evaluated on a study cohort consisting of 1288 breast lesions categorized as BI-RADS 3 and 4. SWE shows an excellent intraobserver reliability and a moderate interobserver reliability in the evaluation of solid breast masses.
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Affiliation(s)
- Riku Togawa
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Pfob
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Sarah Fastner
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | | | - Manuela Goncalo
- Department of Radiology, University of Coimbra, Coimbra, Portugal
| | - André Hennigs
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Kristina Killinger
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Nees
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Riedel
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Schäfgen
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Jörg Heil
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Richard Barr
- Department of Radiology, Northeast Ohio Medical University, Ravenna, USA
| | - Michael Golatta
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
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Forster T, Köhler C, Dorn M, Häfner MF, Arians N, König L, Harrabi SB, Schlampp I, Weykamp F, Meixner E, Lang K, Heinrich V, Weidner N, Hüsing J, Wallwiener M, Golatta M, Hennigs A, Heil J, Hof H, Krug D, Debus J, Hörner-Rieber J. Noninferiority of Local Control and Comparable Toxicity of Intensity Modulated Radiation Therapy With Simultaneous Integrated Boost in Breast Cancer: 5-Year Results of the IMRT-MC2 Phase III Trial. Int J Radiat Oncol Biol Phys 2023; 117:857-868. [PMID: 37244626 DOI: 10.1016/j.ijrobp.2023.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The IMRT-MC2 trial was conducted to demonstrate the noninferiority of conventionally fractionated intensity modulated radiation therapy with a simultaneous integrated boost to 3-dimensional conformal radiation therapy with a sequential boost for adjuvant breast radiation therapy. METHODS AND MATERIALS A total of 502 patients were randomized between 2011 and 2015 for the prospective, multicenter, phase III trial (NCT01322854). Five-year results of late toxicity (late effects normal tissue task force-subjective, objective, management, and analytical), overall survival, disease-free survival, distant disease-free survival, cosmesis (Harvard scale), and local control (noninferiority margin at hazard ratio [HR] of 3.5) were analyzed after a median follow-up of 62 months. RESULTS The 5-year local control rate for the intensity modulated radiation therapy with simultaneous integrated boost arm was non-inferior to the control arm (98.7% vs 98.3%, respectively; HR, 0.582; 95% CI, 0.119-2.375; P = .4595). Furthermore, there was no significant difference in overall survival (97.1% vs 98.3%, respectively; HR, 1.235; 95% CI, 0.472-3.413; P = .6697), disease-free survival (95.8% vs 96.1%, respectively; HR, 1.130; 95% CI, 0.487-2.679; P = .7758), and distant disease-free survival (97.0% vs 97.8%, respectively; HR, 1.667; 95% CI, 0.575-5.434; P = .3601). After 5 years, late toxicity evaluation and cosmetic assessment further showed no significant differences between treatment arms. CONCLUSIONS The 5-year results of the IMRT-MC2 trial provide strong evidence that the application of conventionally fractionated simultaneous integrated boost irradiation for patients with breast cancer is both safe and effective, with noninferior local control compared with 3-dimensional conformal radiation therapy with sequential boost.
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Affiliation(s)
- Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Clara Köhler
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Melissa Dorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Felix Häfner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Semi Ben Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Vanessa Heinrich
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Nicola Weidner
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Johannes Hüsing
- Division of Biostatistics, Coordination Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Holger Hof
- Strahlentherapie Rhein-Pfalz, Neustadt, Germany
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Department of Radiation Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium, partner site Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
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Schäfgen B, Haller A, Sinn HP, Feisst M, Gomez C, Stieber A, Nees J, Togawa R, Pfob A, Hennigs A, Hederer J, Riedel F, Fastner S, Heil J, Golatta M. Conventional specimen radiography in breast-conserving therapy: a useful tool for intraoperative margin assessment after neoadjuvant therapy? Breast Cancer Res Treat 2023:10.1007/s10549-023-06976-2. [PMID: 37302085 DOI: 10.1007/s10549-023-06976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE A previous study in our breast unit showed that the diagnostic accuracy of intraoperative specimen radiography and its potential to reduce second surgeries in a cohort of patients treated with neoadjuvant chemotherapy were low, which questions the routine use of Conventional specimen radiography (CSR) in this patient group. This is a follow-up study in a larger cohort to further evaluate these findings. METHODS This retrospective study included 376 cases receiving breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) of primary breast cancer. CSR was performed to assess potential margin infiltration and recommend an intraoperative re-excision of any radiologically positive margin. The histological workup of the specimen served as gold standard for the evaluation of the accuracy of CSR and the potential reduction of second surgeries by CSR-guided re-excisions. RESULTS 362 patients with 2172 margins were assessed. The prevalence of positive margins was 102/2172 (4.7%). CSR had a sensitivity of 37.3%, a specificity of 85.6%, a positive predictive value (PPV) of 11.3%, and a negative predictive value (NPV) of 96.5%. The rate of secondary procedures was reduced from 75 to 37 with a number needed to treat (NNT) of CSR-guided intraoperative re-excisions of 10. In the subgroup of patients with clinical complete response (cCR), the prevalence of positive margins was 38/1002 (3.8%), PPV was 6.5% and the NNT was 34. CONCLUSION This study confirms our previous finding that the rate of secondary surgeries cannot be significantly reduced by CSR-guided intraoperative re-excisions in cases with cCR after NACT. The routine use CSR after NACT is questionable, and alternative tools of intraoperative margin assessment should be evaluated.
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Affiliation(s)
- Benedikt Schäfgen
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
| | - Annabelle Haller
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, University of Heidelberg, Heidelberg, Germany
- Institute of Pathology, University Hospital, INF 224, 69120, Heidelberg, Germany
| | - Manuel Feisst
- Institute for Medical Biometry, University of Heidelberg, INF 130.3, 69120, Heidelberg, Germany
| | - Christina Gomez
- Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany
| | - Anne Stieber
- Department of Radiology, University of Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital, INF 110, 69120, Heidelberg, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
| | - Riku Togawa
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
| | - André Pfob
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
| | - André Hennigs
- Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany
| | - Johanna Hederer
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
| | - Sarah Fastner
- Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany
- Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Breast Unit, University Hospital, 69120, Heidelberg, Germany.
- Brustzentrum Heidelberg Klinik St. Elisabeth, Max-Reger-Straße 5-7, 69121, Heidelberg, Germany.
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6
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Togawa R, Hederer J, Ragazzi M, Bruckner T, Fastner S, Gomez C, Hennigs A, Nees J, Pfob A, Riedel F, Schäfgen B, Stieber A, Lux MP, Heil J, Golatta M. Imaging of lumpectomy surface with large field-of-view confocal laser scanning microscopy 'Histolog® scanner' for breast margin assessment in comparison with conventional specimen radiography. Breast 2023; 68:194-200. [PMID: 36842192 PMCID: PMC9988675 DOI: 10.1016/j.breast.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/05/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE The Histolog® Scanner (SamanTree Medical SA, Lausanne, Switzerland) is a large field-of-view confocal laser scanning microscope designed to allow intraoperative margin assessment by the production of histological images ready for assessment in the operating room. We evaluated the feasibility and the performance of the Histolog® Scanner (HS) to correctly identify infiltrated margins in clinical practice of lumpectomy specimens. It was extrapolated if the utilization of the HS has the potential to reduce infiltrated margins and therefore reduce re-operation rates in patients undergoing breast conserving surgery (BCS) due to a primarily diagnosed breast cancer including ductal carcinoma in situ. METHODS This is a single-center, prospective, non-interventional, diagnostic pilot study including 50 consecutive patients receiving BCS. The complete surface of the specimen was scanned using the HS intraoperatively. The surgery and the intraoperative margin assessment of the specimen was performed according to the clinical routine consisting of conventional specimen radiography as well as the clinical impression of the surgeon. Three surgeons and an experienced pathologist assessed the scans produced by the HS for cancer cells on the surface. The potential of the HS to correctly identify involved margins was compared to the results of the conventional specimen radiography alone as well as the clinical routine. The histopathological report served as the gold standard. RESULTS 50 specimens corresponding to 300 surfaces were scanned by the HS. The mean sensitivity of the surgeons to identify involved margins with the HS was 37.5% ± 5.6%, the specificity was 75.2% ± 13.0%. The assessment of resection margins by the pathologist resulted in a sensitivity of 37.5% and a specificity of 81.0%, while the local clinical routine resulted in a sensitivity of 37.5% and a specificity of 78.2%. CONCLUSION Acquisition of high-resolution histological images using the HS was feasible in clinical practice. Sensitivity and specificity were comparable to clinical routine. With more specific training and experience on image interpretation and acquisition, the HS may have the potential to enable more accuracy in the margin assessment of BCS specimens.
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Affiliation(s)
- Riku Togawa
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Johanna Hederer
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Moira Ragazzi
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Thomas Bruckner
- Institute of Medical Biometry (IMBI), Heidelberg University, 69120, Heidelberg, Germany
| | - Sarah Fastner
- Breast Unit, Sankt Elisabeth Hospital, 69121, Heidelberg, Germany
| | - Christina Gomez
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - André Hennigs
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Juliane Nees
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - André Pfob
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Benedikt Schäfgen
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise Paderborn, St. Josefs-Krankenhaus, 33098, Salzkotten, Germany
| | - Jörg Heil
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany; Breast Unit, Sankt Elisabeth Hospital, 69121, Heidelberg, Germany
| | - Michael Golatta
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany; Breast Unit, Sankt Elisabeth Hospital, 69121, Heidelberg, Germany.
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7
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von Au A, Shencoru S, Uhlmann L, Mayer L, Michel L, Wallwiener M, Hennigs A, Deutsch T, Riedel F, Heil J, Golatta M, Schneeweiss A, Schütz F, Domschke C. Predictive value of neutrophil-to-lymphocyte-ratio in neoadjuvant-treated patients with breast cancer. Arch Gynecol Obstet 2023; 307:1105-1113. [PMID: 35980458 PMCID: PMC10023763 DOI: 10.1007/s00404-022-06726-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Breast cancer (BC) is the most common malignancy among women and prognosis is strongly influenced by tumor subtype. Neoadjuvant chemotherapy (NAC) is the standard treatment for both locally advanced- and early-stage triple-negative and Her2-positive BC. Pathologic complete response (pCR) to NAC is an important predictor of patient outcomes. Neutrophil-to-lymphocyte-ratio (NLR) in peripheral blood is associated with prognosis in various malignancies. Here, we investigated the value of the pretreatment NLR as a response predictor in neoadjuvant-treated patients with BC. METHODS A retrospective chart analysis of 862 patients with invasive BC treated with NAC at the Heidelberg University Hospital during 2003-2015 was conducted. NLR was calculated as the ratio of the absolute neutrophil and lymphocyte counts in peripheral blood, and pCR was defined as absence of invasive or in situ carcinoma in breast and axillary lymph nodes. RESULTS A total of 151 patients with invasive BC who underwent NAC were included in this study. NLR tended to be higher in the pCR group than the non-pCR group (p < 0.1). Analyses of BC subtypes demonstrated that NLR was significantly higher in the pCR- compared with the non-pCR group (3.304 vs. 2.379, respectively; p = 0.048) in patients with luminal B/Her2-negative tumors. Further, we found a significant difference in NLR according to remission status in postmenopausal patients (2.861 vs. 2.313, respectively; p = 0.043). CONCLUSION NLR was significantly higher only for patients achieving pCR in the Luminal B/Her2-negative and postmenopausal subgroups. Hence, NLR is a candidate additional predictive factor in patients with Luminal B/Her2-negative BC.
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Affiliation(s)
- Alexandra von Au
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany.
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, INF 460, 69120, Heidelberg, Germany.
| | - Samra Shencoru
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, INF 130.3, 69120, Heidelberg, Germany
| | - Luisa Mayer
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Laura Michel
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, INF 460, 69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Thomas Deutsch
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, INF 460, 69120, Heidelberg, Germany
| | - Florian Schütz
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Women's Hospital, INF 440, 69120, Heidelberg, Germany
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8
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Nguyen HT, De Allegri M, Heil J, Hennigs A. Population-Level Impact of Omitting Axillary Lymph Node Dissection in Early Breast Cancer Women: Evidence from an Economic Evaluation in Germany. Appl Health Econ Health Policy 2023; 21:275-287. [PMID: 36409454 PMCID: PMC9676848 DOI: 10.1007/s40258-022-00771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The American College of Surgeons Oncology Group Z0011 trial showed that complete axillary lymph node dissection (cALND) did not improve survival benefits in patients with one or two tumour-involved sentinel lymph nodes and undergoing breast conservation. Still, a considerable number of the Z0011-eligible patients continue to be treated with cALND in various countries. Given the potential economic gain from implementation of the Z0011 recommendations, we quantified population-level impacts of omitting cALND among Z0011-eligible patients in clinical practice. METHODS This 2-year economic analysis adopted both the perspective of patients under statutory insurance and the societal perspective, using data collected prospectively from 179 German breast cancer units between 2008 and 2015. The estimation of cost savings and health gain relied on a single decision tree, which considered three scenarios: clinical practice at the baseline; actual implementation in routine care; and hypothetical full implementation in all eligible patients. RESULTS Data for 188,909 patients with primary breast cancer were available, 13,741 (7.3%) of whom met the Z0011 inclusion criteria. The use of cALND decreased from 94.3% in 2010 to 46.9% in 2015, resulting in a gain of 335 quality-adjusted life-years and a saving of EUR50,334,756 for the society. Had cALND been omitted in all eligible patients, the total gain would have been more than double. CONCLUSIONS The implementation of the Z0011 recommendations resulted in substantial savings and health gain in Germany. Our findings suggest that it is beneficial to introduce additional policy measures to promote further uptake of the Z0011 recommendations in clinical practice.
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Affiliation(s)
- Hoa Thi Nguyen
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany.
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany
| | - Jörg Heil
- Breast Unit, University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinik St. Elisabeth, Heidelberg, Germany
| | - André Hennigs
- Breast Unit, University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinik St. Elisabeth, Heidelberg, Germany
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9
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Togawa R, Pfob A, Büsch C, Alwafai Z, Balleyguier C, Clevert DA, Duda V, Fastner S, Goncalo M, Gomez C, Gruber I, Hahn M, Hennigs A, Kapetas P, Nees J, Ohlinger R, Riedel F, Rutten M, Schäfgen B, Stieber A, Tozaki M, Wojcinski S, Rauch G, Heil J, Barr R, Golatta M. Potential of Lesion-to-Fat Elasticity Ratio Measured by Shear Wave Elastography to Reduce Benign Biopsies in BI-RADS 4 Breast Lesions. J Ultrasound Med 2023. [PMID: 36789976 DOI: 10.1002/jum.16192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES We evaluated whether lesion-to-fat ratio measured by shear wave elastography in patients with Breast Imaging Reporting and Data System (BI-RADS) 3 or 4 lesions has the potential to further refine the assessment of B-mode ultrasound alone in breast cancer diagnostics. METHODS This was a secondary analysis of an international diagnostic multicenter trial (NCT02638935). Data from 1288 women with breast lesions categorized as BI-RADS 3 and 4a-c by conventional B-mode ultrasound were analyzed, whereby the focus was placed on differentiating lesions categorized as BI-RADS 3 and BI-RADS 4a. All women underwent shear wave elastography and histopathologic evaluation functioning as reference standard. Reduction of benign biopsies as well as the number of missed malignancies after reclassification using lesion-to-fat ratio measured by shear wave elastography were evaluated. RESULTS Breast cancer was diagnosed in 368 (28.6%) of 1288 lesions. The assessment with conventional B-mode ultrasound resulted in 53.8% (495 of 1288) pathologically benign lesions categorized as BI-RADS 4 and therefore false positives as well as in 1.39% (6 of 431) undetected malignancies categorized as BI-RADS 3. Additional lesion-to-fat ratio in BI-RADS 4a lesions with a cutoff value of 1.85 resulted in 30.11% biopsies of benign lesions which correspond to a reduction of 44.04% of false positives. CONCLUSIONS Adding lesion-to-fat ratio measured by shear wave elastography to conventional B-mode ultrasound in BI-RADS 4a breast lesions could help reduce the number of benign biopsies by 44.04%. At the same time, however, 1.98% of malignancies were missed, which would still be in line with American College of Radiology BI-RADS 3 definition of <2% of undetected malignancies.
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Affiliation(s)
- Riku Togawa
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Pfob
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Zaher Alwafai
- Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | | | - Dirk-André Clevert
- Department of Radiology, University Hospital Munich-Grosshadern, Munich, Germany
| | - Volker Duda
- Department of Gynecology and Obstetrics, University of Marburg, Marburg, Germany
| | - Sarah Fastner
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Manuela Goncalo
- Department of Radiology, University of Coimbra, Coimbra, Portugal
| | | | - Ines Gruber
- Department of Women's Health, University of Tuebingen, Tuebingen, Germany
| | - Markus Hahn
- Department of Women's Health, University of Tuebingen, Tuebingen, Germany
| | - André Hennigs
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Juliane Nees
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralf Ohlinger
- Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | - Fabian Riedel
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthieu Rutten
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedikt Schäfgen
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sebastian Wojcinski
- Department of Senology, Breast Cancer Center, Klinikum Bielfeld Mitte, Bielefeld, Germany
| | | | - Jörg Heil
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Richard Barr
- Department of Radiology, Northeast Ohio Medical University, Ravenna, Ohio, USA
| | - Michael Golatta
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
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10
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Hoffmann AS, Hennigs A, Feisst M, Moderow M, Heublein S, Deutsch TM, Togawa R, Schäfgen B, Wallwiener M, Golatta M, Heil J, Riedel F. Impact of age on indication for chemotherapy in early breast cancer patients: results from 104 German institutions from 2008 to 2017. Arch Gynecol Obstet 2023; 308:219-229. [PMID: 36604331 DOI: 10.1007/s00404-022-06902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Today, the decision to treat patients with chemotherapy for early breast cancer (EBC) is made based on the patient's individual risk stratification and tumor biology. In cases with chemotherapy indication, the neoadjuvant application (NACT) is the preferred option in comparison with primary surgery and adjuvant chemotherapy (ACT). Age remains a relevant factor in the decision-making process. The aim of the present study was to illustrate the impact of age on the use of systemic therapy in clinical routine. METHODS The study separately analyzed chemotherapy use among six age cohorts of EBC patients who had been treated at 104 German breast units between January 2008 and December 2017. RESULTS In total, 124,084 patients were included, 46,279 (37.3%) of whom had received chemotherapy. For 44,765 of these cases, detailed information on treatment was available. Within this cohort, chemotherapy was administered as NACT to 14,783 patients (33.0%) and as ACT to 29,982 (67.0%) patients. Due to the higher prevalence of unfavorable tumor subtypes, younger patients had a higher rate of chemotherapy (≤ 29y: 74.2%; 30-39y: 71.3%) and a higher proportion of NACT administration ( ≤ 29y: 66.9%; 30-39y: 56.0%) in comparison with elderly patients, who had lower rates for overall chemotherapy (60-69y: 37.5%; ≥ 70y: 17.6%) and NACT (60-69y: 25.5%; ≥ 70y: 22.8%). Pathologic complete response was higher in younger than in older patients (≤ 29y: 30.4% vs. ≥ 70y: 16.7%), especially for HER2- subtypes. CONCLUSION The data from the nationwide German cohort reveal relevant age-dependent discrepancies concerning the use of chemotherapy for EBC.
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Affiliation(s)
- Ann Sophie Hoffmann
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg, Germany
| | - Thomas Maximilian Deutsch
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Riku Togawa
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Benedikt Schäfgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- Heidelberg Breast Center at the St. Elisabeth Clinic, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- Heidelberg Breast Center at the St. Elisabeth Clinic, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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11
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Pfob A, Sidey-Gibbons C, Barr RG, Duda V, Alwafai Z, Balleyguier C, Clevert DA, Fastner S, Gomez C, Goncalo M, Gruber I, Hahn M, Hennigs A, Kapetas P, Lu SC, Nees J, Ohlinger R, Riedel F, Rutten M, Schaefgen B, Stieber A, Togawa R, Tozaki M, Wojcinski S, Xu C, Rauch G, Heil J, Golatta M. Intelligent multi-modal shear wave elastography to reduce unnecessary biopsies in breast cancer diagnosis (INSPiRED 002): a retrospective, international, multicentre analysis. Eur J Cancer 2022; 177:1-14. [PMID: 36283244 DOI: 10.1016/j.ejca.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Breast ultrasound identifies additional carcinomas not detected in mammography but has a higher rate of false-positive findings. We evaluated whether use of intelligent multi-modal shear wave elastography (SWE) can reduce the number of unnecessary biopsies without impairing the breast cancer detection rate. METHODS We trained, tested, and validated machine learning algorithms using SWE, clinical, and patient information to classify breast masses. We used data from 857 women who underwent B-mode breast ultrasound, SWE, and subsequent histopathologic evaluation at 12 study sites in seven countries from 2016 to 2019. Algorithms were trained and tested on data from 11 of the 12 sites and externally validated using the additional site's data. We compared findings to the histopathologic evaluation and compared the diagnostic performance between B-mode breast ultrasound, traditional SWE, and intelligent multi-modal SWE. RESULTS In the external validation set (n = 285), intelligent multi-modal SWE showed a sensitivity of 100% (95% CI, 97.1-100%, 126 of 126), a specificity of 50.3% (95% CI, 42.3-58.3%, 80 of 159), and an area under the curve of 0.93 (95% CI, 0.90-0.96). Diagnostic performance was significantly higher compared to traditional SWE and B-mode breast ultrasound (P < 0.001). Unlike traditional SWE, positive-predictive values of intelligent multi-modal SWE were significantly higher compared to B-mode breast ultrasound. Unnecessary biopsies were reduced by 50.3% (79 versus 159, P < 0.001) without missing cancer compared to B-mode ultrasound. CONCLUSION The majority of unnecessary breast biopsies might be safely avoided by using intelligent multi-modal SWE. These results may be helpful to reduce diagnostic burden for patients, providers, and healthcare systems.
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Affiliation(s)
- André Pfob
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany; MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, USA. https://twitter.com/@andrepfob
| | - Chris Sidey-Gibbons
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, USA. https://twitter.com/@DrCGibbons
| | - Richard G Barr
- Department of Radiology, Northeast Ohio Medical University, Ravenna, USA
| | - Volker Duda
- Department of Gynecology and Obstetrics, University of Marburg, Marburg, Germany
| | - Zaher Alwafai
- Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | | | - Dirk-André Clevert
- Department of Radiology, University Hospital Munich-Grosshadern, Munich, Germany
| | - Sarah Fastner
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Gomez
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuela Goncalo
- Department of Radiology, University of Coimbra, Coimbra, Portugal
| | - Ines Gruber
- Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - Markus Hahn
- Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - André Hennigs
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy Medical University of Vienna
| | - Sheng-Chieh Lu
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Juliane Nees
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralf Ohlinger
- Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | - Fabian Riedel
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthieu Rutten
- Department of Radiology, Jeroen Bosch Hospital, 'S-Hertogenbosch, The Netherlands. Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Benedikt Schaefgen
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Riku Togawa
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sebastian Wojcinski
- Breast Cancer Center/Department of Gynecology and Obstetrics, Klinikum Bielefeld, Germany
| | - Cai Xu
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Joerg Heil
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany.
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12
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Togawa R, Binder LL, Feisst M, Barr RG, Fastner S, Gomez C, Hennigs A, Nees J, Pfob A, Schäfgen B, Stieber A, Riedel F, Heil J, Golatta M. Shear wave elastography as a supplemental tool in the assessment of unsuspicious axillary lymph nodes in patients undergoing breast ultrasound examination. Br J Radiol 2022; 95:20220372. [DOI: 10.1259/bjr.20220372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: To define reference values for shear wave elastography (SWE) in unsuspicious axillary lymph nodes in patients undergoing breast ultrasound examination. Methods: In total, 177 clinically and sonographically unsuspicious axillary lymph nodes were prospectively evaluated with SWE using Virtual Touch Tissue Imaging Quantification (VTIQ) in 175 women. Mean values of tissue stiffness for axillary fatty tissue, lymph node cortex, and lymph node hilus were measured. Additionally, test-retest reliability of SWE in the assessment of axillary lymph node stiffness was evaluated by repeating each measurement three times. Results: In 177 axillary lymph nodes, the mean stiffness of lymph node cortex, hilus, and surrounding fatty tissue as quantified by SWE was 1.90 m/s (SD: 0.34 m/s), 2.02 m/s (SD: 0.37 m/s), and 1.75 m/s (SD: 0.38 m/s), respectively. The mean stiffness of cortex and hilus was significantly higher compared to fatty tissue (p < 0.0001). SWE demonstrated good test–retest reliability in the assessment of stiffness of the lymph node hilus, cortex, and the surrounding fatty tissue with an intraclass correlation of 0.79 (95% CI: 0.75; 0.83), 0.75 (95% CI: 0.70; 0.79), and 0.78 (95% CI: 0.74; 0.82), respectively, (p < 0.0001). Conclusions: Reference values for SWE in unsuspicious axillary lymph nodes are determined. These results may help to better identify axillary lymph node metastasis for breast cancer patients when combined with other lymph node features. SWE is a reliable method for the objective quantification of tissue stiffness of axillary lymph nodes. Advances in knowledge: This study presents physiological reference values for tissue stiffness by examining the axillary lymph nodes with SWE in 175 women with sonomorphologically unsuspicious lymph nodes.
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Affiliation(s)
- Riku Togawa
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Leah-Larissa Binder
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry (IMBI), Heidelberg University, Heidelberg, Germany
| | - Richard G. Barr
- Department of Radiology, Northeastern Ohio Medical University, OH, United States
| | - Sarah Fastner
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Christina Gomez
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hennigs
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Nees
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Pfob
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Schäfgen
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Riedel
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörg Heil
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Michael Golatta
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
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13
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Riedel M, Amann N, Recker F, Hennigs A, Heublein S, Meyer B, Karge A, Eisenkolb G, Lammert J, Graf A, Klein E, Weiss M, Riedel F. The COVID-19 pandemic and its impact on medical teaching in obstetrics and gynecology—A nationwide expert survey among teaching coordinators at German university hospitals. PLoS One 2022; 17:e0269562. [PMID: 35930549 PMCID: PMC9355177 DOI: 10.1371/journal.pone.0269562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/24/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose The COVID-19 pandemic has imposed severe challenges on medical education at German university hospitals. In this first German nationwide expert survey, we addressed the responsible university teaching coordinators in obstetrics and gynecology departments and investigated their experiences during the pandemic as well as their opinions on future developments, especially with regard to the broader implementation of e-learning in the standard curriculum. Methods The questionnaire included 42 items and was disseminated among teaching coordinators at all 41 departments of obstetrics and gynecology at German university hospitals via an email that included a weblink to the online survey provider. Responses were collected between 19 April and 7 June 2021. Results In total, 30 responses were collected from 41 departments across Germany and their respective teaching coordinators in obstetrics and gynecology. The general opinion of the medical teaching provided during the pandemic was positive, whereas the teaching quality in practical skills was considered inferior and not equivalent to the standard face-to-face curriculum. Lectures and seminars had to be substituted by remote-learning alternatives, while clinical clerkships were reduced in length and provided less patient contact. Students in their final year experienced only a few differences in the clinical and teaching routine. Teaching coordinators in obstetrics and gynecology stated that they intend to incorporate more e-learning into the curriculum in the future. Conclusion The medical educators’ views presented here may help to complement the already-thoroughly investigated experiences of students under the restrictions of the COVID-19 pandemic. Medical educators in obstetrics and gynecology at German university hospitals have successfully established online and hybrid teaching alternatives to their standard face-to-face courses. Building on recent experiences, digitalization could help to improve future medical education.
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Affiliation(s)
- Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
- * E-mail:
| | - Niklas Amann
- Department of Gynecology and Obstetrics, Friedrich–Alexander-University Erlangen–Nuremberg (FAU), Erlangen, Germany
| | - Florian Recker
- Department of Gynecology and Obstetrics, Bonn University Hospital, Bonn, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Bastian Meyer
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Anne Karge
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Gabriel Eisenkolb
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Jacqueline Lammert
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Anna Graf
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich (TU), Munich, Germany
| | - Martin Weiss
- Department of Women’s Health, University of Tübingen, Tübingen, Germany
- NMI Natural and Medical Sciences Institute, University of Tübingen, Reutlingen, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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14
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Tietz S, Bodenbeck L, Riedel F, Wallwiener M, Hennigs A, Heublein S. How to make students satisfied with digital teaching? Investigative results from teaching evaluations in Gynecology and Obstetrics. Arch Gynecol Obstet 2022; 306:1587-1596. [PMID: 35852646 PMCID: PMC9294823 DOI: 10.1007/s00404-022-06645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose
The aim of this study was to investigate whether students’ attitude towards online learning in Gynecology and Obstetrics changed during the COVID-19 pandemic. We further examined which variables impacted students’ satisfaction with digital learning.
Methods
A specifically developed questionnaire was used from June 2020–July 2021 for N = 234 medical students participating in the course “Gynecology and Obstetrics” at University of Heidelberg. Thirty-five items were repeatedly applied in different cohorts to assess structure- and content-related quality of teaching. In addition, their influence on overall satisfaction with digital teaching was analyzed by applying investigative analyses like multiple regression and extreme group comparisons.
Results
Especially items associated with content-related quality of teaching (β = 0.24), organization of teaching (β = 0.25) and subjective learning success (β = 0.27) seemed to be relevant predictors for overall satisfaction with courses. Fears and changes due to the pandemic situation also played a role for a subgroup of students. Aspects linked to technical quality of teaching, interactions with teachers and students or advantages of web-based learning appeared to play a subordinate role for overall satisfaction with digital teaching. Comparisons of ratings over time revealed that teaching evaluations almost remained the same.
Conclusion
Our results give several hints regarding how digital teaching should be designed and how it can be improved. Further studies are needed to validate our results and to develop methods to improve digital teaching in medicine.
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Affiliation(s)
- Steffen Tietz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Laura Bodenbeck
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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15
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Forster T, Köhler C, Dorn M, Häfner MF, Arians N, König L, Harrabi SB, Schlampp I, Meixner E, Heinrich V, Weidner N, Golatta M, Hennigs A, Heil J, Hof H, Krug D, Debus J, Hörner-Rieber J. Methods of Esthetic Assessment after Adjuvant Whole-Breast Radiotherapy in Breast Cancer Patients: Evaluation of the BCCT.core Software and Patients' and Physicians' Assessment from the Randomized IMRT-MC2 Trial. Cancers (Basel) 2022; 14:cancers14123010. [PMID: 35740675 PMCID: PMC9221255 DOI: 10.3390/cancers14123010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary To validate the BCCT.core software, the present analysis compares the esthetics assessment by the software in relation to patients’ and physicians’ rating in breast cancer patients after surgery and adjuvant radiotherapy. Agreement rates of the different assessments and their correlation with breast asymmetry indices were evaluated. The assessments of the software and the physicians were significantly correlated with all asymmetry indices, while for patients’ self-assessment, this general correlation was first seen after 2 years. Only a slight agreement between the BCCT.core software and the physicians’ or patients’ assessment was seen, while a moderate and substantial agreement was detected between the physicians’ and the patients’ assessments. The BCCT.core software is a reliable tool to measure asymmetries, but may not sufficiently evaluate the esthetic outcome as perceived by patients. It may be more appropriate for a long-term follow-up, when symmetry seems to increase in importance. Abstract The present analysis compares the esthetics assessment by the BCCT.core software in relation to patients’ and physicians’ ratings, based on the IMRT-MC2 trial. Within this trial, breast cancer patients received breast-conserving surgery (BCS) and adjuvant radiotherapy. At the baseline, 6 weeks, and 2 years after radiotherapy, photos of the breasts were assessed by the software and patients’ and physicians’ assessments were performed. Agreement rates of the assessments and their correlation with breast asymmetry indices were evaluated. The assessments of the software and the physicians were significantly correlated with asymmetry indices. Before and 6 weeks after radiotherapy, the patients’ self-assessment was only correlated with the lower breast contour (LBC) and upward nipple retraction (UNR), while after 2 years, there was also a correlation with other indices. Only a slight agreement between the BCCT.core software and the physicians’ or patients’ assessment was seen, while a moderate and substantial agreement was detected between the physicians’ and the patients’ assessment after 6 weeks and 2 years, respectively. The BCCT.core software is a reliable tool to measure asymmetries, but may not sufficiently evaluate the esthetic outcome as perceived by patients. It may be more appropriate for a long-term follow-up, when symmetry appears to increase in importance.
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Affiliation(s)
- Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Clara Köhler
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
| | - Melissa Dorn
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
| | - Matthias Felix Häfner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Semi Ben Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Vanessa Heinrich
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, 72070 Tuebingen, Germany; (V.H.); (N.W.)
| | - Nicola Weidner
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, 72070 Tuebingen, Germany; (V.H.); (N.W.)
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, 69115 Heidelberg, Germany; (M.G.); (A.H.); (J.H.)
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, 69115 Heidelberg, Germany; (M.G.); (A.H.); (J.H.)
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, 69115 Heidelberg, Germany; (M.G.); (A.H.); (J.H.)
| | - Holger Hof
- Strahlentherapie Rhein-Pfalz, 67433 Neustadt, Germany;
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiation Oncology, University Hospital Schleswig Holstein, 24105 Kiel, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (T.F.); (C.K.); (M.D.); (M.F.H.); (N.A.); (L.K.); (S.B.H.); (I.S.); (E.M.); (D.K.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-8201; Fax: +49-6221-5353
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16
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Pfob A, Barr RG, Duda V, Büsch C, Bruckner T, Spratte J, Nees J, Togawa R, Ho C, Fastner S, Riedel F, Schaefgen B, Hennigs A, Sohn C, Heil J, Golatta M. A New Practical Decision Rule to Better Differentiate BI-RADS 3 or 4 Breast Masses on Breast Ultrasound. J Ultrasound Med 2022; 41:427-436. [PMID: 33942358 DOI: 10.1002/jum.15722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The BI-RADS classification provides a standardized way to describe ultrasound findings in breast cancer diagnostics. However, there is little information regarding which BI-RADS descriptors are most strongly associated with malignancy, to better distinguish BI-RADS 3 (follow-up imaging) and 4 (diagnostic biopsy) breast masses. METHODS Patients were recruited as part of an international, multicenter trial (NCT02638935). The trial enrolled 1294 women (6 excluded) categorized as BI-RADS 3 or 4 upon routine B-mode ultrasound examination. Ultrasound images were evaluated by three expert physicians according to BI-RADS. All patients underwent histopathological confirmation (reference standard). We performed univariate and multivariate analyses (chi-square test, logistic regression, and Krippendorff's alpha). RESULTS Histopathologic evaluation showed malignancy in 368 of 1288 masses (28.6%). Upon performing multivariate analysis, the following descriptors were significantly associated with malignancy (P < .05): age ≥50 years (OR 8.99), non-circumscribed indistinct (OR 4.05) and microlobulated margin (OR 2.95), nonparallel orientation (OR 2.69), and calcification (OR 2.64). A clinical decision rule informed by these results demonstrated a 97% sensitivity and missed fewer cancers compared to three physician experts (range of sensitivity 79-95%) and a previous decision rule (sensitivity 59%). Specificity was 44% versus 22-83%, respectively. The inter-reader reliability of the BI-RADS descriptors and of the final BI-RADS score was fair-moderate. CONCLUSIONS A patient should undergo a diagnostic biopsy (BI-RADS 4) instead of follow-up imaging (BI-RADS 3) if the patient is 50 years or older or exhibits at least one of the following features: calcification, nonparallel orientation of mass, non-circumscribed margin, or posterior shadowing.
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Affiliation(s)
- André Pfob
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard G Barr
- Department of Radiology, Northeast Ohio Medical University, Ravenna, Ohio, USA
| | - Volker Duda
- Department of Gynecology and Obstetrics, University of Marburg, Marburg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Julia Spratte
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Riku Togawa
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Chi Ho
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sarah Fastner
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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17
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Pfob A, Sidey-Gibbons C, Barr RG, Duda V, Alwafai Z, Balleyguier C, Clevert DA, Fastner S, Gomez C, Goncalo M, Gruber I, Hahn M, Hennigs A, Kapetas P, Lu SC, Nees J, Ohlinger R, Riedel F, Rutten M, Schaefgen B, Schuessler M, Stieber A, Togawa R, Tozaki M, Wojcinski S, Xu C, Rauch G, Heil J, Golatta M. The importance of multi-modal imaging and clinical information for humans and AI-based algorithms to classify breast masses (INSPiRED 003): an international, multicenter analysis. Eur Radiol 2022; 32:4101-4115. [PMID: 35175381 PMCID: PMC9123064 DOI: 10.1007/s00330-021-08519-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/14/2021] [Accepted: 10/17/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES AI-based algorithms for medical image analysis showed comparable performance to human image readers. However, in practice, diagnoses are made using multiple imaging modalities alongside other data sources. We determined the importance of this multi-modal information and compared the diagnostic performance of routine breast cancer diagnosis to breast ultrasound interpretations by humans or AI-based algorithms. METHODS Patients were recruited as part of a multicenter trial (NCT02638935). The trial enrolled 1288 women undergoing routine breast cancer diagnosis (multi-modal imaging, demographic, and clinical information). Three physicians specialized in ultrasound diagnosis performed a second read of all ultrasound images. We used data from 11 of 12 study sites to develop two machine learning (ML) algorithms using unimodal information (ultrasound features generated by the ultrasound experts) to classify breast masses which were validated on the remaining study site. The same ML algorithms were subsequently developed and validated on multi-modal information (clinical and demographic information plus ultrasound features). We assessed performance using area under the curve (AUC). RESULTS Of 1288 breast masses, 368 (28.6%) were histopathologically malignant. In the external validation set (n = 373), the performance of the two unimodal ultrasound ML algorithms (AUC 0.83 and 0.82) was commensurate with performance of the human ultrasound experts (AUC 0.82 to 0.84; p for all comparisons > 0.05). The multi-modal ultrasound ML algorithms performed significantly better (AUC 0.90 and 0.89) but were statistically inferior to routine breast cancer diagnosis (AUC 0.95, p for all comparisons ≤ 0.05). CONCLUSIONS The performance of humans and AI-based algorithms improves with multi-modal information. KEY POINTS • The performance of humans and AI-based algorithms improves with multi-modal information. • Multimodal AI-based algorithms do not necessarily outperform expert humans. • Unimodal AI-based algorithms do not represent optimal performance to classify breast masses.
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Affiliation(s)
- André Pfob
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany ,grid.240145.60000 0001 2291 4776MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Chris Sidey-Gibbons
- grid.240145.60000 0001 2291 4776MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX USA ,grid.240145.60000 0001 2291 4776Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Richard G. Barr
- grid.261103.70000 0004 0459 7529Department of Radiology, Northeast Ohio Medical University, Ravenna, OH USA
| | - Volker Duda
- grid.10253.350000 0004 1936 9756Department of Gynecology and Obstetrics, University of Marburg, Marburg, Germany
| | - Zaher Alwafai
- grid.5603.0Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | - Corinne Balleyguier
- grid.14925.3b0000 0001 2284 9388Department of Radiology, Institut Gustave Roussy, Villejuif Cedex, France
| | - Dirk-André Clevert
- grid.411095.80000 0004 0477 2585Department of Radiology, University Hospital Munich-Grosshadern, Munich, Germany
| | - Sarah Fastner
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Christina Gomez
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Manuela Goncalo
- grid.8051.c0000 0000 9511 4342Department of Radiology, University of Coimbra, Coimbra, Portugal
| | - Ines Gruber
- grid.10392.390000 0001 2190 1447Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - Markus Hahn
- grid.10392.390000 0001 2190 1447Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - André Hennigs
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Panagiotis Kapetas
- grid.22937.3d0000 0000 9259 8492Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sheng-Chieh Lu
- grid.240145.60000 0001 2291 4776MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX USA ,grid.240145.60000 0001 2291 4776Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Juliane Nees
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Ralf Ohlinger
- grid.5603.0Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | - Fabian Riedel
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Matthieu Rutten
- grid.413508.b0000 0004 0501 9798Department of Radiology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands ,grid.10417.330000 0004 0444 9382Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedikt Schaefgen
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Maximilian Schuessler
- grid.5253.10000 0001 0328 4908National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Riku Togawa
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | | | - Sebastian Wojcinski
- grid.461805.e0000 0000 9323 0964Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Cai Xu
- grid.240145.60000 0001 2291 4776MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX USA ,grid.240145.60000 0001 2291 4776Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Geraldine Rauch
- grid.7468.d0000 0001 2248 7639Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin , Germany
| | - Joerg Heil
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Michael Golatta
- grid.5253.10000 0001 0328 4908University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
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18
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Riedel M, Hennigs A, Dobberkau AM, Riedel C, Bugaj TJ, Nikendei C, Amann N, Karge A, Eisenkolb G, Tensil M, Recker F, Riedel F. The role of gender-specific factors in the choice of specialty training in obstetrics and gynecology: results from a survey among medical students in Germany. Arch Gynecol Obstet 2022; 305:129-137. [PMID: 34550446 PMCID: PMC8782790 DOI: 10.1007/s00404-021-06232-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The field of obstetrics and gynecology (OB/GYN) is facing growing competition for young professionals in Germany, with high interest rates among female graduates and a declining proportion of male students who choose residency training in the field. The aim of this study is to analyze general and gender-dependent factors that influence the decision for or against specialty training in OB/GYN among medical students in Germany. METHODS Between February and November 2019, n = 346 medical students in their 5th and 6th year of undergraduate training at Heidelberg University received a questionnaire with 44 items. RESULTS n = 286 students (61.3 female; 38.7% male) participated in the study. 28% of the female students and 9% of the male students had considered OB/GYN for their specialty training. The students reported different general and gender-specific influencing factors in their choice of a specialty. Both genders desired a good work-life-balance, however, in comparison with their female colleagues, male students had heavily weighted factors related to their later careers and professional success, including competition among colleagues. Male students had gained little practical experience during compulsory internships (26.9% for females vs. 8.8% for males) or had chosen their final-year elective in OB/GYN (15.9% for females vs. 5.5% for males). Female students had worried about the negative effects of their sex on their career (35.4% for females vs. 5.9% for males). CONCLUSION OB/GYN must become more appealing and attractive to young female and male professionals alike. A better compatibility of career and family should go hand in hand with the implementation of differentiated, (extra) curricular teaching approaches that take the different preferences of female and male students into account.
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Affiliation(s)
- Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna Maria Dobberkau
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Caroline Riedel
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Niklas Amann
- Department of Obstetrics and Gynecology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Anne Karge
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gabriel Eisenkolb
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria Tensil
- Kirinus Clinic for Psychotherapy, Munich, Germany
| | - Florian Recker
- Department of Obstetrics and Gynecology, Bonn University Hospital, Bonn, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.
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Nees LK, Grozinger P, Orthmann N, Rippinger N, Hennigs A, Sohn C, Domschke C, Wallwiener M, Rom J, Riedel F. The Influence of Different Genres of Music on the Performance of Medical Students on Standardized Laparoscopic Exercises. J Surg Educ 2021; 78:1709-1716. [PMID: 33812805 DOI: 10.1016/j.jsurg.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Whether and how music influences the performance of surgical procedures such as laparoscopy is unclear and can be feasibly determined using laparoscopic box training tools under standardized conditions. The aim of this prospective study is to evaluate the effect of different genres of music on the performance of laparoscopic novices. METHODS Between May 2018 and December 2018, n = 82 students (38 male, 44 female) from Heidelberg University Medical School performed 3 different laparoscopic exercises (A, B, C) from the "Luebecker Toolbox" with 2 repetitions each under standardized conditions. Time was recorded for each exercise. The students were assigned either to one of four groups, each of which was exposed to a compilation of music from 1 genre (hip hop, classical, rock, or mixed radio music), or to a fifth, control group, without exposure to music. The music was played at a constant sound pressure level of 70 decibels . Each group was compared with the others using a t-test for independent samples. RESULTS Exposure to music generally led to better performance compared with the control group. Compared with exposure to mixed radio music or to rock, significantly better performance could be demonstrated for exposure to classical music in Exercise B, with an average exposure time of 127 s needed (± 21.4; p < 0.05). No significant differences could be demonstrated for Exercise A, though for classical music, best performance was possible with 120 s (±17.3) of exposure. In Exercise C, hip hop triggered significantly better performance than rock or radio music (p < 0.05). CONCLUSIONS At an sound pressure level of 70 decibels, exposure to classical music or hip hop appears to have beneficial effects on training performance for surgical novices under standardized conditions.
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Affiliation(s)
- Lisa Katharina Nees
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Philipp Grozinger
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Natalie Orthmann
- Asklepios Hospital Hamburg-Barmbek, Department of Gynecology and Obstetrics, Hamburg, Germany
| | - Nathalie Rippinger
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - André Hennigs
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Christof Sohn
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Christoph Domschke
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Markus Wallwiener
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Joachim Rom
- Frankfurt-Hoechst Hospital, Department of Gynecology and Obstetrics, Frankfurt, Germany
| | - Fabian Riedel
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany.
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20
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Stolpner I, Heil J, Riedel F, Wallwiener M, Schäfgen B, Feißt M, Golatta M, Hennigs A. ASO Visual Abstract: Long-Term Patient Satisfaction and Quality of Life after Breast-Conserving Therapy-A Prospective Study Using the BREAST-Q. Ann Surg Oncol 2021. [PMID: 34365556 DOI: 10.1245/s10434-021-10408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Benedikt Schäfgen
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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21
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Stolpner I, Heil J, Riedel F, Wallwiener M, Schäfgen B, Feißt M, Golatta M, Hennigs A. Long-Term Patient Satisfaction and Quality of Life After Breast-Conserving Therapy: A Prospective Study Using the BREAST-Q. Ann Surg Oncol 2021; 28:8742-8751. [PMID: 34279753 PMCID: PMC8591011 DOI: 10.1245/s10434-021-10377-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022]
Abstract
Background Poor patient-reported satisfaction after breast-conserving therapy (BCT) has been associated with impaired health-related quality of life (HRQOL) and subsequent depression in retrospective analysis. This prospective cohort study aimed to assess the HRQOL of patients who have undergone BCT using the BREAST-Q, and to identify clinical risk factors for lower patient satisfaction. Methods Patients with primary breast cancer undergoing BCT were asked to complete the BREAST-Q preoperatively (T1) for baseline evaluation, then 3 to 4 weeks postoperatively (T2), and finally 1 year after surgery (T3). Clinicopathologic data were extracted from the patients’ charts. Repeated measures analysis of variance (ANOVA) was used to determine significant differences in mean satisfaction and well-being levels among the test intervals. Multiple linear regression was used to evaluate risk factors for lower satisfaction. Results The study enrolled 250 patients. The lowest baseline BREAST-Q score was reported for “satisfaction with breast” (mean, 61 ± 19), but this increased postoperatively (mean, 66 ± 18) and was maintained at the 1 year follow-up evaluation (mean, 67 ± 21). “Physical well-being” decreased from T1 (mean, 82 ± 17) to T2 (mean, 28 ± 13) and did not recover much by T3 (mean, 33 ± 13), being the lowest BREAST-Q score postoperatively and in the 1-year follow-up evaluation. In multiple regression, baseline psychosocial well-being, body mass index (BMI), and type of incision were risk factors for lower “satisfaction with breasts.” Conclusion Both the aesthetic/surgery-related and psychological aspects are equally important with regard to “satisfaction with breasts” after BCT. The data could serve as the benchmark for future studies.
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Affiliation(s)
- Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Benedikt Schäfgen
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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Schäfgen B, Juskic M, Radicke M, Hertel M, Barr R, Pfob A, Togawa R, Nees J, von Au A, Fastner S, Harcos A, Gomez C, Stieber A, Riedel F, Hennigs A, Sohn C, Heil J, Golatta M. Evaluation of the FUSION-X-US-II prototype to combine automated breast ultrasound and tomosynthesis. Eur Radiol 2021; 31:3712-3720. [PMID: 33313983 PMCID: PMC8128739 DOI: 10.1007/s00330-020-07573-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The FUSION-X-US-II prototype was developed to combine 3D automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device. We evaluated the performance of ABUS and tomosynthesis in a single examination in a clinical setting. METHODS In this prospective feasibility study, digital breast tomosynthesis and ABUS were performed using the FUSION-X-US-II prototype without any change of the breast position in patients referred for clarification of breast lesions with an indication for tomosynthesis. The tomosynthesis and ABUS images of the prototype were interpreted independently from the clinical standard by a breast diagnostics specialist. Any detected lesion was classified using BI-RADS® scores, and results of the standard clinical routine workup (gold standard) were compared to the result of the separate evaluation of the prototype images. Image quality was rated subjectively and coverage of the breast was measured. RESULTS One hundred one patients received both ABUS and tomosynthesis using the prototype. The duration of the additional ABUS acquisition was 40 to 60 s. Breast coverage by ABUS was approximately 80.0%. ABUS image quality was rated as diagnostically useful in 86 of 101 cases (85.1%). Thirty-three of 34 malignant breast lesions (97.1%) were identified using the prototype. CONCLUSION The FUSION-X-US-II prototype allows a fast ABUS scan in combination with digital breast tomosynthesis in a single device integrated in the clinical workflow. Malignant breast lesions can be localized accurately with direct correlation of ABUS and tomosynthesis images. The FUSION system shows the potential to improve breast cancer screening in the future after further technical improvements. KEY POINTS • The FUSION-X-US-II prototype allows the combination of automated breast ultrasound and digital breast tomosynthesis in a single device without decompression of the breast. • Image quality and coverage of ABUS are sufficient to accurately detect malignant breast lesions. • If tomosynthesis and ABUS should become part of breast cancer screening, the combination of both techniques in one device could offer practical and logistic advantages. To evaluate a potential benefit of a combination of ABUS and tomosynthesis in screening-like settings, further studies are needed.
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Affiliation(s)
- Benedikt Schäfgen
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Marija Juskic
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | | | | | - Richard Barr
- Northeastern Ohio Medical University and Southwoods Imaging, Youngstown, OH, USA
| | - André Pfob
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Riku Togawa
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Sarah Fastner
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Aba Harcos
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Christina Gomez
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Anne Stieber
- Department of Radiology, University Breast Unit, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany.
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23
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Nees LK, Grozinger P, Orthmann N, Deutsch TM, Hennigs A, Domschke C, Wallwiener M, Rom J, Riedel F. Evaluating the influence of music at different sound pressure levels on medical students' performance of standardized laparoscopic box training exercises. BMC Med Educ 2021; 21:209. [PMID: 33849503 PMCID: PMC8042978 DOI: 10.1186/s12909-021-02627-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The influence of music on the performance of surgical procedures such as laparoscopy is controversial and methodologically difficult to quantify. Here, outcome measurements using laparoscopic box training tools under standardized conditions might offer a feasible approach. To date, the effect of music exposure at different sound pressure levels (SPL) on outcome has not been evaluated systematically for laparoscopic novices. METHODS Between May 2017 and October 2018, n = 87 students (49 males, 38 females) from Heidelberg University Medical School performed three different laparoscopy exercises using the "Luebecker Toolbox" that were repeated twice under standardized conditions. Time was recorded for each run. All students were randomly assigned to four groups exposed to the same music compilation but at different SPLs (50-80 dB), an acoustically shielded (earplug) group, or a control group (no intervention). RESULTS Best absolute performance was shown under exposure to 70 dB in all three exercises (a, b, c) with mean performance time of 121, 142, and 115 s (p < 0.05 for a and c). For the control group mean performance times were 157, 144, and 150 s, respectively. In the earplug group, no significant difference in performance was found compared to the control group (p > 0.05) except for exercise (a) (p = 0.011). CONCLUSION Music exposure seems to have beneficial effects on training performance. In comparison to the control group, significantly better results were reached at 70 dB SPL, while exposure to lower (50 or 60 dB) or higher (80 dB) SPL as well as under acoustic shielding did not influence performance.
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Affiliation(s)
- Lisa Katharina Nees
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Philipp Grozinger
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Natalie Orthmann
- Asklepios Klinik Hamburg-Altona, Department of Gynecology and Obstetric, Hamburg, Germany
| | - Thomas Maximilian Deutsch
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Joachim Rom
- Klinikum Frankfurt-Hoechst, Department of Gynecology and Obstetrics, Frankfurt, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany.
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Fathi A, Hennigs A, Addo MM. [Less is more… in infectious diseases]. Internist (Berl) 2021; 62:373-378. [PMID: 33580310 DOI: 10.1007/s00108-021-00967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing development of antimicrobial resistance has been identified as one of the greatest threats to public health and is caused to a relevant extent by falsely indicated antibiotic treatment. OBJECTIVE The main aim of this article is to identify areas in infectious disease diagnostics and treatment where overuse occurs and to provide recommendations on how to avoid it. MATERIAL AND METHODS The authors identified current and relevant studies on the topic of medical overuse in infectious diseases via a literature search. In particular, contributions from international "less is more" initiatives were included. The focus was on areas in which a reduction of diagnostic and therapeutic measures leads to an optimization of patient outcomes. RESULTS In many cases overuse in the context of diagnostics and treatment of infectious diseases not only leads to an unnecessary financial burden on the healthcare system and is not beneficial but can also increase the risk of development of antimicrobial resistance and have adverse consequences for patients. CONCLUSION Correct indications as well as focused selection and adequate application of antimicrobial agents is crucial to provide the best possible medical care. Diagnostic and antibiotic stewardship measures, which should be implemented in collaboration with infectious disease specialists, can help to identify and reduce areas of overuse and misuse.
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Affiliation(s)
- A Fathi
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - A Hennigs
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - M M Addo
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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25
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Riedel F, Schaefgen B, Sinn HP, Feisst M, Hennigs A, Hug S, Binnig A, Gomez C, Harcos A, Stieber A, Kauczor HU, Sohn C, Golatta M, Glaeser A, Heil J. Diagnostic accuracy of axillary staging by ultrasound in early breast cancer patients. Eur J Radiol 2020; 135:109468. [PMID: 33338758 DOI: 10.1016/j.ejrad.2020.109468] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Axillary ultrasound (AUS) is a standard procedure in the preoperative clinical identification of axillary metastatic lymph node (LN) involvement. It guides decisions about local and systemic therapy for patients with early breast cancer (EBC). But there is only weak evidence on the diagnostic criteria and standard interpretation. The aim of this study was to assess the performance of AUS in the detection and exclusion of LN metastases. METHODS In a retrospective single-center study, 611 consecutive EBC patients with 622 axillae underwent AUS +/- core needle biopsy (CNB) plus axillary surgery, i.e. sentinel lymph node biopsy and/or axillary lymph node dissection. For all patients, AUS image documentation of at least the most suspicious LN was saved during the initial diagnostic work-up. The diagnostic outcome measures were sensitivity, specificity, accuracy, Youden-index (YI), and diagnostic odds ratio (DOR) on the basis of the daily routine interpretation and on the basis of previously recommended diagnostic criteria by two blinded examiners. RESULTS On the basis of the daily routine interpretation, AUS had a sensitivity (95 % CI) of 53.3 % (46.4-60.1), a specificity (95 % CI) of 93.6 % (90.8-95.8), an accuracy (95 % CI) of 79.7 % (76.4-82.8), a YI (95 % CI) of 0.47 (0.40 - 0.54), and a DOR (95 % CI) of 16.75 (10.37-27.05). Systematic application of previously recommended diagnostic criteria did not improve the diagnostic accuracy of routinely interpreted AUS. CONCLUSION AUS performance alone is not sufficient to accurately identify or exclude axillary metastatic disease in unselected patients with EBC.
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Affiliation(s)
- Fabian Riedel
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Hans-Peter Sinn
- Institute of Pathology, University Hospital of Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Germany
| | - André Hennigs
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Sarah Hug
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Angela Binnig
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Christina Gomez
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Aba Harcos
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Germany
| | - Christof Sohn
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Michael Golatta
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Antonia Glaeser
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany.
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Riedel F, Heil J, Feißt M, Moderow M, von Au A, Domschke C, Michel L, Schäfgen B, Golatta M, Hennigs A. Can the eligibility criteria of the ACOSOG Z0011 trial be extended to patients undergoing mastectomy and presenting T3-T4 tumors? An analysis of non-sentinel axillary metastases. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie und Informatik
| | | | - A von Au
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - C Domschke
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - L Michel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - B Schäfgen
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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Platzer L, Orthmann N, Grozinger P, Hennigs A, Rippinger N, Wallwiener M, Rom J, Riedel F. Does music genre affect medical students’ performance in standardized laparoscopic exercises? Comparing exposure to rock, hip-hop, classic and mixed radio music at 70 decibels. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L.K. Platzer
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N. Orthmann
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - P. Grozinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A. Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N. Rippinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M. Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J. Rom
- Klinikum Frankfurt-Höchst, Frauenklinik
| | - F. Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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Riedel M, Hennigs A, Dobberkau AM, Deutsch T, Rippinger N, Wallwiener M, Finkenzeller C, Golatta M, Heil J, Riedel F. Evaluation genderspezifischer Faktoren und Assoziationen für die Wahl zur Facharztweiterbildung in der Gynäkologie und Geburtshilfe – Ergebnisse einer Befragung unter Medizinstudierenden im klinischen Studienabschnitt. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Riedel
- Klinikum rechts der Isar der Technischen Universität München, Frauenklinik
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A.-M Dobberkau
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - T Deutsch
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - N Rippinger
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - C Finkenzeller
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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29
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Riedel F, Hoffmann AS, Moderow M, Heublein S, Deutsch T, Golatta M, Wallwiener M, Schneeweiss A, Heil J, Hennigs A. Wie hat sich die Anwendung von adjuvanter zu neoadjuvanter Chemotherapie beim frühen Mammakarzinom verändert? – Daten von 104 deutschen Brustzentren 2008-2017. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - AS Hoffmann
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | | | - S Heublein
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - T Deutsch
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Golatta
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
- Nationales Centrum für Tumorerkrankungen
- Deutsches Krebsforschungszentrum
| | - J Heil
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
| | - A Hennigs
- Universitätsklinikum Heidelberg, Universitäts-Frauenklinik Heidelberg
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Schäfgen B, Riedel F, Sinn P, Feisst M, Hennigs A, Hug S, Binning A, Sohn C, Golatta M, Gläser A, Heil J. Diagnostic accuracy and clinical utility of axillary ultrasound in the evaluation of axillary lymph node status in early breast cancer patients. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | | | - M Feisst
- Institute of Medical Biometry and Informatics
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31
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Stefanovic S, TM D, Riethdorf S, Fischer C, Hartkopf A, Sinn P, Feisst M, Pantel K, Hennigs A, Golatta M, Sütterlin M, Schneeweiss A, Wallwiener M. Receptor discordance between primary tumor and metastasis influences CTC-status. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Stefanovic
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - Deutsch TM
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - S Riethdorf
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - C Fischer
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - A Hartkopf
- Universitätsfrauenklinik, Universitätsklinikum Tübingen
| | - P Sinn
- Institut für Pathologie, Universitätsklinikum Heidelberg
| | - M Feisst
- Institut für Medizinische Biometrie und Informatik, Universitätsklinikum Heidelberg
| | - K Pantel
- Institut für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf
| | - A Hennigs
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Golatta
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
| | - M Sütterlin
- Universitätsfrauenklinik, Universitätsklinikum Mannheim, Universität Heidelberg
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen (NCT)
- Deutsches Krebsforschungszentrum (DKFZ)
| | - M Wallwiener
- Universitätsfrauenklinik, Universitätsklinikum Heidelberg
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32
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Riedel F, Heil J, Feisst M, Moderow M, von Au A, Domschke C, Michel L, Schaefgen B, Golatta M, Hennigs A. Analyzing non-sentinel axillary metastases in patients with T3-T4 cN0 early breast cancer and tumor-involved sentinel lymph nodes undergoing breast-conserving therapy or mastectomy. Breast Cancer Res Treat 2020; 184:627-636. [PMID: 32816190 PMCID: PMC7599150 DOI: 10.1007/s10549-020-05876-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/10/2020] [Indexed: 11/12/2022]
Abstract
Purpose In the ACOSOG Z0011 trial, completing axillary lymph node dissection (cALND) did not benefit patients with T1–T2 cN0 early breast cancer and 1–2 positive sentinel lymph nodes (SLN) undergoing breast-conserving surgery (BCT). This paper reports cALND rates in the clinical routine for patients who had higher (T3–T4) tumor stages and/or underwent mastectomy but otherwise met the ACOSOG Z0011 eligibility criteria. Aim of this study is to determine cALND time trends and non-sentinel axillary metastases (NSAM) rates to estimate occult axillary tumor burden. Methods Data were included from patients treated in 179 German breast cancer centers between 2008 and 2015. Time-trend rates were analyzed for cALND of patients with T3–T4 tumors separated for BCT and mastectomy and regarding presence of axillary macrometastases or micrometastases. Results Data were available for 188,909 patients, of whom 19,009 were identified with 1–2 positive SLN. Those 19,009 patients were separated into 4 cohorts: (1) Patients with T1–T2 tumors receiving BCT (ACOSOG Z0011 eligible; n = 13,741), (2) T1–T2 with mastectomy (n = 4093), (3) T3–T4 with BCT (n = 269), (4) T3–T4 with mastectomy (n = 906). Among patients with T3–T4 tumors, cALND rates declined from 2008 to 2015: from 88.2 to 62.6% for patients receiving mastectomy and from 96.6 to 58.1% in patients receiving BCT. Overall rates for any NSAM after cALND for cohorts 1–4 were 33.4%, 42.3%, 46.9%, 58.8%, respectively. Conclusions The cALND rates have decreased substantially in routine care in patients with ‘extended’ ACOSOG Z0011 eligibility criteria. Axillary tumor burden is higher in these patients than in the ACOSOG Z0011 trial.
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Affiliation(s)
- Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Mareike Moderow
- West German Breast Center GmbH, Bahlenstr. 180, 40589, Düsseldorf, Germany
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Laura Michel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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33
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Riedel F, Hoffmann AS, Moderow M, Heublein S, Deutsch TM, Golatta M, Wallwiener M, Schneeweiss A, Heil J, Hennigs A. Time trends of neoadjuvant chemotherapy for early breast cancer. Int J Cancer 2020; 147:3049-3058. [PMID: 32468577 DOI: 10.1002/ijc.33122] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/25/2020] [Accepted: 05/14/2020] [Indexed: 11/09/2022]
Abstract
Neoadjuvant chemotherapy (NACT) in early breast cancer (EBC) enables in vivo sensitivity testing and less radical surgery as compared to primary surgery and adjuvant chemotherapy (ACT). The aim of our study is to illustrate trends of systemic treatment of EBC. The study analyzed chemotherapy usage and time trends for patients with EBC treated at 104 German breast units between January 2008 and December 2017. The data were obtained through a quality-controlled benchmarking process. Altogether, 124 084 patients were included, of whom 46 279 (37.3%) received chemotherapy. For 44 765 of these cases, detailed information on systemic treatment and surgery were available. Overall use of chemotherapy declined from 42.0% in 2008 to 32.0% in 2017. During that same time, the proportion of NACT increased from 20.0% to 57.7%, irrespective of tumor subtype. The pathological complete response (pCR) rate (defined as ypT0 ypN0) at surgery after NACT increased from 15.0% to 34.2%. The results from this large cohort from the clinical routine reflect the refined indications for chemotherapy in EBC.
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Affiliation(s)
- Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Ann Sophie Hoffmann
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sabine Heublein
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas M Deutsch
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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34
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Maier AM, Heil J, Harcos A, Sinn HP, Rauch G, Uhlmann L, Gomez C, Stieber A, Funk A, Barr RG, Hennigs A, Riedel F, Schäfgen B, Hug S, Marmé F, Sohn C, Golatta M. Prediction of pathological complete response in breast cancer patients during neoadjuvant chemotherapy: Is shear wave elastography a useful tool in clinical routine? Eur J Radiol 2020; 128:109025. [PMID: 32371182 DOI: 10.1016/j.ejrad.2020.109025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the validity of Shear Wave Elastography (SWE) for the preoperative assessment of pathological complete response (pCR) to standard clinical assessment in breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS This prospective, consecutive clinical trial was conducted under routine clinical practice. Analysis included 134 patients. SWE served as index test, final pathology from surgical specimen as reference standard. PCR (ypT0) was defined as primary endpoint. Elasticity changes were compared for the pCR- vs. non-pCR group. To determine the validity of shear wave velocity (Vs), ROC analyses and diagnostic accuracy parameters were calculated and compared to the final standard clinical assessment by physical examination, mammography and B-mode ultrasound (ycT + vs. ycT0). RESULTS Vs was significantly reduced in pCR and non-pCR groups during NACT (pCR: ΔVs(abs) = 3.90 m/s, p < 0.001; non-pCR: ΔVs(abs) = 3.10 m/s, p < 0.001). The pCR-group showed significant lower Vs for all control visits (t1,2,END: p < 0.001). ROC analysis of Vs yielded moderate AUCs for the total population (t0: 0.613, t1: 0.745, t2: 0.685, tEND: 0.718). Compared to standard clinical assessment, Vs(tEND) (cut-off: ≤3.35 m/s) was superior in sensitivity (79.6 % vs. 54.5 %), NPV (86.4 % vs. 77.5 %), FNR (20.4 % vs. 45.5 %), inferior in specificity (58.6 % vs. 77.5 %), PPV (46.3 % vs. 54.5 %), FPR (41.4 % vs. 22.5 %). CONCLUSION SWE measures significant differences in tumour elasticity changes in pCR vs. non-pCR cases. SWE shows improved sensitivity compared to standard clinical assessment, high NPV and low FNR, but failed in specificity in order to predict pCR under routine conditions.
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Affiliation(s)
- Anna Marie Maier
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Aba Harcos
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, Heidelberg University, Heidelberg, Germany
| | - Geraldine Rauch
- Charité Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health Berlin, Berlin, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Christina Gomez
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University, Heidelberg, Germany
| | - Annika Funk
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio and Radiology Consultants Inc., Youngstown, Ohio, USA
| | - André Hennigs
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Benedikt Schäfgen
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Sarah Hug
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Frederik Marmé
- Experimental & Translational Gynecological Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Christof Sohn
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology, Breast Unit, Heidelberg University, Heidelberg, Germany.
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Pfob A, Koelbel V, Schuetz F, Feißt M, Blumenstein M, Hennigs A, Golatta M, Heil J. Surgeon's preference of subcutaneous tissue resection: most important factor for short-term complications in subcutaneous implant placement after mastectomy-results of a cohort study. Arch Gynecol Obstet 2020; 301:1037-1045. [PMID: 32157414 PMCID: PMC7103012 DOI: 10.1007/s00404-020-05481-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Abstract
Purpose Little is known about the reason of high short-term complication rates after the subcutaneous placement of breast implants or expanders after mastectomy without biological matrices or synthetic meshes. This study aims to evaluate complications and their risk factors to develop guidelines for decreasing complication rates. Methods We included all cases of mastectomy followed by subcutaneous implant or expander placement between 06/2017 and 05/2018 (n = 92). Mean follow-up time was 12 months. Results Explantation occurred in 15 cases (16.3%). The surgeon’s preference for moderate vs. radical subcutaneous tissue resection had a significant influence on explantation rates (p = 0.026), impaired wound healing or infection (requiring surgery) (p = 0.029, p = 0.003 respectively) and major complications (p = 0.018). Multivariate analysis revealed significant influence on complication rates for radical subcutaneous tissue resection (p up to 0.003), higher implant volume (p up to 0.023), higher drain volume during the last 24 h (p = 0.049), higher resection weight (p = 0.035) and incision type (p = 0.011). Conclusion Based on the significant risk factors we suggest the following guidelines to decrease complication rates: favoring thicker skin envelopes after surgical preparation, using smaller implants, removing drains based on a low output volume during the last 24 h and no use of periareolar incision with extension medial or lateral. We should consider ADMs for subcutaneous one-stage reconstructions. The individual surgeon’s preference of subcutaneous tissue resection is of highest relevance for short-term complications—this has to be part of internal team discussions and should be considered in future trials for comparable results.
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Affiliation(s)
- André Pfob
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Vivian Koelbel
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Maria Blumenstein
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology, Breast Center, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Stolpner I, Heil J, Hennigs A. ASO Author Reflections: The BREAST-Q BCT Module and Its Use in Clinical Practice. Ann Surg Oncol 2019; 26:788-789. [PMID: 31617118 DOI: 10.1245/s10434-019-07939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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Feißt M, Heil J, Stolpner I, von Au A, Domschke C, Sohn C, Kieser M, Rauch G, Hennigs A. Psychometric validation of the Breast Cancer Treatment Outcome Scale (BCTOS-12): a prospective cohort study. Arch Gynecol Obstet 2019; 300:1679-1686. [PMID: 31705285 DOI: 10.1007/s00404-019-05362-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The Breast Cancer Treatment Outcome Scale (BCTOS) is a questionnaire to evaluate the aesthetic and functional outcome after breast conserving surgery (BCS). The original BCTOS with its 22 items on three subscales was refined to a shorter, improved, and easier to administer patient-reported outcome measure, the BCTOS-12. The BCTOS-12 consists of 12 items on two distinct subscales, the Functional Status and the Aesthetic Status. The aim of this study was to validate the BCTOS-12 in a prospective cohort. METHODS For this study, 239 breast cancer patients were included preoperatively, and 204 patients completed the BCTOS-12 and EORTC QLQ C30 BR23 shortly after their BCS, corresponding to a follow-up rate of 85%. The item-factor structure was examined by confirmatory factor analysis. The reliability was calculated by McDonald's Omega for estimating internal consistency. The convergent validity was assessed by Spearman's rank correlation coefficients between the related scales of the questionnaires. RESULTS The BCTOS-12 showed a robust item-factor structure and a good internal consistency with McDonald's Omega of 0.89 for the Aesthetic Status and 0.90 for the Functional Status. A high convergent and divergent validity was indicated by correlations between the subscales of the EORTC QLQ C30 BR23 and the BCTOS-12. CONCLUSION Overall, the results demonstrate a successful psychometric validation of the BCTOS-12. The BCTOS-12 is a refined, improved, and now validated, instrument. It can be used in clinical studies and routine management for the evaluation of the aesthetic and functional outcome after BCS.
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Affiliation(s)
- Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Institute of Biometry and Clinical Epidemiology, Charité University Hospital Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Stolpner I, Hennigs A. Response to: Comments on the Clinical Validation of the BREAST-Q Breast-Conserving Therapy Module, by Hernanz et al. Ann Surg Oncol 2019; 26:857-858. [PMID: 31463698 DOI: 10.1245/s10434-019-07756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
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Feißt M, Hennigs A, Heil J, Moosbrugger H, Kelava A, Stolpner I, Kieser M, Rauch G. Refining scores based on patient reported outcomes - statistical and medical perspectives. BMC Med Res Methodol 2019; 19:167. [PMID: 31366326 PMCID: PMC6670170 DOI: 10.1186/s12874-019-0806-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 07/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background Patient Reported Outcomes (PRO) are gaining more and more importance in the context of clinical trials. The assessment of PRO is frequently performed by questionnaires where the multiple items of a questionnaire are usually pooled within summarizing scores. These scores are used as variables to measure subjective aspects of treatments and diseases. In clinical research, the calculation of these scores is mostly kept very simple, e.g. by a simple summation of item values. In the medical literature, there is hardly any guidance for performing a refinements of questionnaires and for deducing adequate scores. In contrast, in psychometric literature, there are plenty of more sophisticated methods, which overcome typical assumptions made in traditional (sum) scores, however to the prize of more complicated algorithms, which might be difficult to communicate. When faced with the practical task to refine an existing questionnaire, there exist a clear gap of guidance for applied medical researchers. By this article we try to fill this important gap between psychometric theory and medical application by illustrating our methodological choices on the example of a clinical PRO questionnaire. Methods Based on our experiences with the refinement of the BCTOS, a PRO questionnaire to assess aesthetic and function after breast conserving therapy in breast cancer patients, we present the following general steps that we performed by refining the BCTOS questionnaire and its scores: 1. Refinement of the length of the questionnaire and the (item-factor) structure. 2. Selection of the factor score estimation method. 3. Validation of the refined questionnaire and scores with respect to validity, reliability and structure based on a validation cohort. Results Our step-step-step procedure helped us to shorten the current form of the BCTOS and to redefine the factor structure. By this, the compliance of patients can be increased and the interpretation of the results becomes more coherent. Conclusions We present a step-by-step procedure to refine an existing medical questionnaire along with its scores illustrated and discussed by the refinement of the BCTOS. Trial registration Due to the character of the study (no intervention study), no registration was performed.
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Affiliation(s)
- Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany.
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Helfried Moosbrugger
- Department of Psychology, Johann Wolfgang Goethe University, Theodor-W.-Adorno-Platz 6, D-60323, Frankfurt am Main, Germany
| | - Augustin Kelava
- Methods Center, Eberhard Karls University, Hölderlinstr. 29, D-72074, Tübingen, Germany
| | - Ilona Stolpner
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, D-69120, Heidelberg, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, D-10117, Berlin, Germany.,Berlin Institute of Health, Anna-Lousia-Karsch 2, D-10178, Berlin, Germany
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Riedel F, Heil J, Feißt M, Rezai M, Moderow M, Sohn C, Schütz F, Golatta M, Hennigs A. Non-sentinel axillary tumor burden applying the ACOSOG Z0011 eligibility criteria to a large routine cohort. Breast Cancer Res Treat 2019; 177:457-467. [DOI: 10.1007/s10549-019-05327-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
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Michel LL, Sommer L, González Silos R, Lorenzo Bermejo J, von Au A, Seitz J, Hennigs A, Smetanay K, Golatta M, Heil J, Schütz F, Sohn C, Schneeweiss A, Marmé F. Locoregional risk assessment after neoadjuvant chemotherapy in patients with primary breast cancer: clinical utility of the CPS + EG score. Breast Cancer Res Treat 2019; 177:437-446. [DOI: 10.1007/s10549-019-05314-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/05/2019] [Indexed: 12/28/2022]
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Stolpner I, Heil J, Feißt M, Karsten MM, Weber WP, Blohmer JU, Forster T, Golatta M, Schütz F, Sohn C, Hennigs A. Clinical Validation of the BREAST-Q Breast-Conserving Therapy Module. Ann Surg Oncol 2019; 26:2759-2767. [DOI: 10.1245/s10434-019-07456-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Indexed: 12/14/2022]
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Hennigs A, Riedel F, Feißt M, Köpke M, Rezai M, Nitz U, Moderow M, Golatta M, Sohn C, Heil J. Evolution of the Use of Completion Axillary Lymph Node Dissection in Patients with T1/2N0M0 Breast Cancer and Tumour-Involved Sentinel Lymph Nodes Undergoing Mastectomy: A Cohort Study. Ann Surg Oncol 2019; 26:2435-2443. [PMID: 31049766 DOI: 10.1245/s10434-019-07388-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND In breast cancer, completion axillary lymph node dissection (cALND) was previously recommended for patients with at least one tumour-affected sentinel lymph node (SLN). Several prospective trials predominantly in patients undergoing breast-conserving surgery showed no benefit and increased arm morbidity with this procedure. We report the influence of these trials on clinical practice of patients undergoing mastectomy. METHODS We analysed prospectively collected data from patients with primary invasive breast cancer treated at German breast cancer units between January 2008 and December 2015. Time trends of cALND rates were analysed in patients undergoing mastectomy for T1/2N0M0 breast cancer with one or two tumour-involved SLNs. Multivariable logistic regression was used to determine factors influencing the decision not to perform cALND. RESULTS Among the entire study cohort of 166,074 patients treated at 179 breast cancer units, 4093 patients (2%) had T1/2N0M0 breast cancer with one or two tumour-involved SLNs and underwent mastectomy. cALND rates decreased from 89.9% in 2010 to 55.5% in 2015 (p < 0.001). Rates decreased from 82% to 8% in patients with micrometastatic SLN disease and from 93% to 63% in those with macrometastasis (p < 0.001). In multivariable analysis, factors associated with omission of cALND were treatment at a general, nonacademic hospital, pT1 status, older age, higher number of removed SLNs, fewer tumour-affected SLNs, and SLN micrometastasis (all p < 0.001). CONCLUSIONS Despite limited evidence from prospective trials relating to the omission of cALND specifically in patients undergoing mastectomy, our nationwide data show that use of cALND decreased in these patients in routine clinical practice.
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Affiliation(s)
- André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Melitta Köpke
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Mahdi Rezai
- European Breast Center, Luisen Hospital, Düsseldorf, Germany
| | - Ulrike Nitz
- Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda, Mönchengladbach, Germany
| | | | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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Michel LL, Sommer L, González Silos R, Lorenzo Bermejo J, von Au A, Seitz J, Hennigs A, Smetanay K, Golatta M, Heil J, Schütz F, Sohn C, Schneeweiss A, Marmé F. Prediction of local recurrence risk after neoadjuvant chemotherapy in patients with primary breast cancer: Clinical utility of the MD Anderson Prognostic Index. PLoS One 2019; 14:e0211337. [PMID: 30703111 PMCID: PMC6355200 DOI: 10.1371/journal.pone.0211337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background Locoregional recurrence after neoadjuvant chemotherapy for primary breast cancer is associated with poor prognosis. It is essential to identify patients at high risk of locoregional recurrence who may benefit from extended local therapy. Here, we examined the prediction accuracy and clinical applicability of the MD Anderson Prognostic Index (MDAPI). Methods Prospective clinical data from 456 patients treated between 2003 and 2011 was analyzed. The Kaplan-Meier method was used to examine the probabilities of locoregional recurrence, local recurrence and distant metastases according to individual prognosis score, stratified by type of surgery (breast conserving therapy or mastectomy). The possible confounding of the relationship between recurrence risk and MDAPI by established risk factors was accounted for in multiple survival regression models. To define the clinical utility of the MDAPI we analyzed its performance to predict locoregional recurrence censoring patients with prior or simultaneous distant metastases. Results Mastectomized patients (42% of the patients) presented with more advanced tumor stage, lower tumor grade, hormone-receptor positive disease and consequently lower pathological complete response rates. Only a few patients presented with high-risk scores (2,7% MDAPI≥3). All patients with high-risk MDAPI score (MDAPI ≥3) who developed locoregional recurrence were simultaneously affected by distant metastases. Conclusion Our data do not support a clinical utility of the MDAPI to guide local therapy.
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Affiliation(s)
- Laura L. Michel
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail: (LM); (FM)
| | - Laura Sommer
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Rosa González Silos
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Justo Lorenzo Bermejo
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Alexandra von Au
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Seitz
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - André Hennigs
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Smetanay
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik Marmé
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail: (LM); (FM)
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Riedel F, Riedel M, Freis A, Heil J, Golatta M, Schuetz F, Sohn C, Hennigs A. Exam preparatory course for the 2nd part of the German medical examination in obstetrics and gynecology - a potential tool for the recruitment of new residents during the occupational decision process before the practical year? BMC Med Educ 2019; 19:24. [PMID: 30654790 PMCID: PMC6335710 DOI: 10.1186/s12909-019-1457-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The "Second Stage of the Physician Exam" at the end of the 5th year of medical school in Germany is the final step before the "Practical Year." An exam preparatory class can cover the complete content of Obstetrics and Gynecology (OB/GYN) in two days. We raise the question of whether such training might promote students' interest in the given specialty during occupational decision making and whether it could even be used by hospitals as a recruitment tool. This investigation is even more important in the context of fierce competition among young professionals at clinics and in different specialties. METHODS We conducted a multimodal course evaluation for four exam preparatory courses (each of which lasted two days and involved 8.5 h of teaching), including pre- and post-course tests with 20 multiple-choice questions to quantify the level of skill gain. Additionally, a standardized evaluation of course satisfaction was performed, followed by a post-exam questionnaire that dealt with studying activities and individual professional objectives. RESULTS Overall, n = 197 students took part in four identical courses. Among them, n = 121 completed the pre-/post-course tests, n = 170 completed the evaluation, and n = 110 completed the post-exam questionnaire. An average improvement from 13.9 to 17.2 correct answers was observed (max. 20; pre-/post-difference 95%-CI: [2.77; 3.86], t-test: p < 0.0001). By trend, the students noted that course participation positively influenced their later choice of specialty training (m = 3.63; scale 1 = "strongly disagree," 5 = "strongly agree"). CONCLUSIONS In addition to self-studying, condensed classroom training is effective and reasonable and might also increase the attractivity of OB/GYN among students and have a positive effect on recruitment.
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Affiliation(s)
- Fabian Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Riedel
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Freis
- Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Hospital, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
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Riedel F, Heil J, Golatta M, Schaefgen B, Hug S, Schott S, Rom J, Schuetz F, Sohn C, Hennigs A. Changes of breast and axillary surgery patterns in patients with primary breast cancer during the past decade. Arch Gynecol Obstet 2018; 299:1043-1053. [PMID: 30478667 DOI: 10.1007/s00404-018-4982-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management. METHODS Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups. RESULTS Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003-2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016. CONCLUSIONS In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management.
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Affiliation(s)
- F Riedel
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - M Golatta
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - B Schaefgen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Hug
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - S Schott
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - J Rom
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - F Schuetz
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - C Sohn
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - A Hennigs
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Hennigs A, Köpke M, Feißt M, Riedel F, Rezai M, Nitz U, Moderow M, Golatta M, Sohn C, Schneeweiss A, Heil J. Which patients with sentinel node-positive breast cancer after breast conservation still receive completion axillary lymph node dissection in routine clinical practice? Breast Cancer Res Treat 2018; 173:429-438. [DOI: 10.1007/s10549-018-5009-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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Riedel F, Heil J, Mahdi R, Nitz U, Moderow M, Golatta M, Schäfgen B, Sohn C, Schütz F, Schneeweiss A, Hennigs A. Chemotherapie-Anwendung beim frühen Mammakarzinom in Deutschland – aktuelle Daten aus 179 Brustkrebszentren (2008 – 2015). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Riedel
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - J Heil
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - R Mahdi
- Europäisches Brustzentrum Dr. Mahdi Rezai, Luisenkrankenhaus, Düsseldorf, Deutschland
| | - U Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum Niederrhein, Mönchengladbach, Deutschland
| | - M Moderow
- Westdeutsches Brust-Centrum GmbH, Düsseldorf, Deutschland
| | - M Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - B Schäfgen
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - C Sohn
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - F Schütz
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
| | - A Schneeweiss
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Deutschland
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Köpke M, Feißt M, Rezai M, Nitz U, Moderow M, Riedel F, Golatta M, Sohn C, Schneeweiss A, Heil J, Hennigs A. Veränderung des axillären Managements bei Brustkrebspatientinnen mit 1 – 2 tumorbefallenen Sentinel-Lymphknoten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Köpke
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Feißt
- Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - M Rezai
- Europäisches Brustzentrum Dr. Mahdi Rezai, Luisenkrankenhaus, Düsseldorf, Deutschland
| | - U Nitz
- Evangelisches Krankenhaus Bethesda, Brustzentrum Niederrhein, Mönchengladbach, Deutschland
| | - M Moderow
- Westdeutsches Brust-Centrum GmbH, Düsseldorf, Deutschland
| | - F Riedel
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Golatta
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Heidelberg, Deutschland
| | - J Heil
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
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Funk A, Schäfgen B, Heil J, Harcos A, Gomez C, Stieber A, Junkermann H, Hennigs A, Rauch G, Sinn HP, Riedel F, Hug S, Meier A, Schott S, Rom J, Schütz F, Sohn C, Golatta M. Evaluation des Nutzens von intraoperativer Präparateradiografie zur Randbeurteilung bei brusterhaltender Therapie maligner Brusttumore. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Funk
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - B Schäfgen
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - J Heil
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Harcos
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Gomez
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Stieber
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - H Junkermann
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Hennigs
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - G Rauch
- Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland
| | - HP Sinn
- Institut für Pathologie und Neuropathologie, Heidelberg, Deutschland
| | - F Riedel
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - S Hug
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - A Meier
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - S Schott
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - J Rom
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - F Schütz
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - C Sohn
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
| | - M Golatta
- Universitätsfrauenklinik Heidelberg, Heidelberg, Deutschland
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