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Kilian M, Friedrich MJ, Lu KHN, Vonhören D, Jansky S, Michel J, Keib A, Stange S, Hackert N, Kehl N, Hahn M, Habel A, Jung S, Jähne K, Sahm F, Betge J, Cerwenka A, Westermann F, Dreger P, Raab MS, Meindl-Beinker NM, Ebert M, Bunse L, Müller-Tidow C, Schmitt M, Platten M. The immunoglobulin superfamily ligand B7H6 subjects T cell responses to NK cell surveillance. Sci Immunol 2024; 9:eadj7970. [PMID: 38701193 DOI: 10.1126/sciimmunol.adj7970] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/15/2024] [Indexed: 05/05/2024]
Abstract
Understanding the mechanisms that regulate T cell immunity is critical for the development of effective therapies for diseases associated with T cell dysfunction, including autoimmune diseases, chronic infections, and cancer. Co-inhibitory "checkpoint molecules," such as programmed cell death protein-1, balance excessive or prolonged immune activation by T cell-intrinsic signaling. Here, by screening for mediators of natural killer (NK) cell recognition on T cells, we identified the immunoglobulin superfamily ligand B7H6 to be highly expressed by activated T cells, including patient-infused CD19-targeting chimeric antigen receptor (CAR) T cells. Unlike other checkpoint molecules, B7H6 mediated NKp30-dependent recognition and subsequent cytolysis of activated T cells by NK cells. B7H6+ T cells were prevalent in the tissue and blood of several diseases, and their abundance in tumor tissue positively correlated with clinical response in a cohort of patients with immune checkpoint inhibitor-treated esophageal cancer. In humanized mouse models, NK cell surveillance via B7H6 limited the persistence and antitumor activity of CAR T cells, and its genetic deletion enhanced T cell proliferation and persistence. Together, we provide evidence of B7H6 protein expression by activated T cells and suggest the B7H6-NKp30 axis as a therapeutically actionable NK cell-dependent immune checkpoint that regulates human T cell function.
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Affiliation(s)
- Michael Kilian
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirco J Friedrich
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kevin Hai-Ning Lu
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Pediatric Hematology and Oncology, Clinic of Pediatrics III, University Hospital Essen, Essen, Germany
| | - David Vonhören
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Selina Jansky
- Department of Pediatric Hematology and Oncology, Clinic of Pediatrics III, University Hospital Essen, Essen, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Julius Michel
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anna Keib
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Saskia Stange
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicolaj Hackert
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Niklas Kehl
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Markus Hahn
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Antje Habel
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanie Jung
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kristine Jähne
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Betge
- Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Medicine II, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Adelheid Cerwenka
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
- Department of Immunobiochemistry, Mannheim Institute for Innate Immunosciences (MI3), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank Westermann
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Dreger
- Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc S Raab
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nadja M Meindl-Beinker
- Department of Medicine II, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Matthias Ebert
- Department of Medicine II, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
| | - Lukas Bunse
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Schmitt
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Platten
- DKTK Clinical Cooperation Unit (CCU) Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
- Helmholtz Institute of Translational Oncology (HI-TRON), Mainz, Germany
- Immune Monitoring Unit, National Center for Tumor Diseases (NCT), Heidelberg, Germany
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2
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Dannehl D, Jakob D, Mergel F, Estler A, Engler T, Volmer L, Frevert ML, Matovina S, Englisch A, Tegeler CM, Rohner A, Seller A, Hahn M, Pfister K, Fink A, Popp I, Lorenz S, Tabatabai G, Juhasz-Böss I, Janni W, Brucker S, Taran FA, Hartkopf A, Schäffler H. The efficacy of sacituzumab govitecan and trastuzumab deruxtecan on stable and active brain metastases in metastatic breast cancer patients-a multicenter real-world analysis. ESMO Open 2024; 9:102995. [PMID: 38636292 PMCID: PMC11039313 DOI: 10.1016/j.esmoop.2024.102995] [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: 01/17/2024] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Fifteen to thirty percent of all patients with metastatic breast cancer (MBC) develop brain metastases (BCBMs). Recently, the antibody-drug conjugates (ADCs) sacituzumab govitecan (SG) and trastuzumab deruxtecan (T-DXd) have shown to be highly effective in the treatment of MBC. However, there are only limited data whether these macromolecules are also effective in patients with BCBMs. We therefore aimed to examine the efficacy of SG and T-DXd in patients with stable and active BCBMs in a multicenter real-world analysis. PATIENTS AND METHODS Female patients with stable or active BCBMs who were treated with either SG or T-DXd at three breast centers in Germany before 30 June 2023 were included. As per local clinical praxis, chemotherapy efficacy was evaluated by whole-body computed tomography and cranial magnetic resonance imaging at baseline and at least every 3 months according to local standards. Growth dynamics of BCBMs were assessed by board-certified neuroradiologists. RESULTS Of 26 patients, with a median of 2.5 prior therapy lines in the metastatic setting (range 2-15), 12 (43%) and 16 (57%) patients received SG and T-DXd, respectively. Out of the 12 patients who received SG, 2 (17%) were subsequently treated with T-DXd. Five out of 12 (42%) and 5 out of 16 (31%) patients treated with SG and T-DXd, respectively, had active BCBMs at treatment initiation. The intracranial disease control rate was 42% [95% confidence interval (CI) 13% to 71%] for patients treated with SG and 88% (95% CI 72% to 100%) for patients treated with T-DXd. After a median follow-up of 12.7 months, median intracranial progression-free survival was 2.7 months (95% CI 1.6-10.5 months) for SG and 11.2 months (95% CI 7.5-23.7 months) for T-DXd. CONCLUSIONS SG and T-DXd showed promising clinical activity in both stable and active BCBMs. Further prospective clinical studies designed to investigate the efficacy of modern ADCs on active and stable BCBMs are urgently needed.
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Affiliation(s)
- D Dannehl
- Department of Women's Health, Tuebingen University, Tuebingen.
| | - D Jakob
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg
| | - F Mergel
- Department of Gynecology and Obstetrics, Ulm University, Ulm
| | - A Estler
- Department of Radiology, Section for Diagnostic and Interventional Neuroradiology, Tuebingen
| | - T Engler
- Department of Women's Health, Tuebingen University, Tuebingen
| | - L Volmer
- Department of Women's Health, Tuebingen University, Tuebingen
| | - M-L Frevert
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg
| | - S Matovina
- Department of Women's Health, Tuebingen University, Tuebingen
| | - A Englisch
- Department of Women's Health, Tuebingen University, Tuebingen
| | - C M Tegeler
- Department of Women's Health, Tuebingen University, Tuebingen
| | - A Rohner
- Department of Women's Health, Tuebingen University, Tuebingen
| | - A Seller
- Department of Women's Health, Tuebingen University, Tuebingen
| | - M Hahn
- Department of Women's Health, Tuebingen University, Tuebingen
| | - K Pfister
- Department of Gynecology and Obstetrics, Ulm University, Ulm
| | - A Fink
- Department of Gynecology and Obstetrics, Ulm University, Ulm
| | - I Popp
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg
| | - S Lorenz
- Department of Radiology, Ulm University, Ulm
| | - G Tabatabai
- Center for Neurooncology, Comprehensive Cancer Center, Tuebingen University, Tuebingen, Germany
| | - I Juhasz-Böss
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg
| | - W Janni
- Department of Gynecology and Obstetrics, Ulm University, Ulm
| | - S Brucker
- Department of Women's Health, Tuebingen University, Tuebingen
| | - F-A Taran
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg
| | - A Hartkopf
- Department of Women's Health, Tuebingen University, Tuebingen; Department of Gynecology and Obstetrics, Ulm University, Ulm
| | - H Schäffler
- Department of Gynecology and Obstetrics, Ulm University, Ulm
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Dannehl D, von Au A, Engler T, Volmer LL, Gutsfeld R, Englisch JF, Hahn M, Hawighorst-Knapstein S, Chaudhuri A, Bauer A, Wallwiener M, Taran FA, Wallwiener D, Brucker SY, Wallwiener S, Hartkopf AD, Dijkstra TMH. Implementation and Evaluation of a Breast Cancer Disease Model Using Real-World Claims Data in Germany from 2010 to 2020. Cancers (Basel) 2024; 16:1490. [PMID: 38672572 PMCID: PMC11049278 DOI: 10.3390/cancers16081490] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Breast cancer is the leading cause of cancer-related mortality among women in Germany and worldwide. This retrospective claims data analysis utilizing data from AOK Baden-Wuerttemberg, a major statutory German health insurance provider, aimed to construct and assess a real-world data breast cancer disease model. The study included 27,869 female breast cancer patients and 55,738 age-matched controls, analyzing data from 2010 to 2020. Three distinct breast cancer stages were analyzed: Stage A (early breast cancer without lymph node involvement), Stage B (early breast cancer with lymph node involvement), and Stage C (primary distant metastatic breast cancer). Tumor subtypes were estimated based on the prescription of antihormonal or HER2-targeted therapy. The study established that 77.9% of patients had HR+ breast cancer and 9.8% HER2+; HR+/HER2- was the most common subtype (70.9%). Overall survival (OS) analysis demonstrated significantly lower survival rates for stages B and C than for controls, with 5-year OS rates ranging from 79.3% for stage B to 35.4% for stage C. OS rates were further stratified by tumor subtype and stage, revealing varying prognoses. Distant recurrence-free survival (DRFS) analysis showed higher recurrence rates in stage B than in stage A, with HR-/HER2- displaying the worst DRFS. This study, the first to model breast cancer subtypes, stages, and outcomes using German claims data, provides valuable insights into real-world breast cancer epidemiology and demonstrates that this breast cancer disease model has the potential to be representative of treatment outcomes.
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Affiliation(s)
- Dominik Dannehl
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, Heidelberg University, 69120 Heidelberg, Germany;
| | - Tobias Engler
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Léa Louise Volmer
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Raphael Gutsfeld
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Johannes Felix Englisch
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Markus Hahn
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | | | - Ariane Chaudhuri
- AOK Baden-Wuerttemberg, 70188 Stuttgart, Germany; (S.H.-K.); (A.C.)
| | - Armin Bauer
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | | | - Florin-Andrei Taran
- Department of Gynecology and Obstetrics, Freiburg University, 79106 Freiburg im Breisgau, Germany;
| | - Diethelm Wallwiener
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Stephanie Wallwiener
- Department of Obstetrics and Perinatal Medicine, Halle University, 06120 Halle, Germany;
| | - Andreas Daniel Hartkopf
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
| | - Tjeerd Maarten Hein Dijkstra
- Department of Women’s Health, Tübingen University, 72076 Tübingen, Germany; (T.E.); (R.G.); (J.F.E.); (M.H.); (A.B.); (D.W.); (S.Y.B.); (A.D.H.); (T.M.H.D.)
- Institute for Translational Bioinformatics, University Hospital Tübingen, 72076 Tübingen, Germany
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Seller A, Tegeler CM, Mauermann J, Schreiber T, Hagelstein I, Liebel K, Koch A, Heitmann JS, Greiner SM, Hayn C, Dannehl D, Engler T, Hartkopf AD, Hahn M, Brucker SY, Salih HR, Märklin M. Soluble NKG2DLs Are Elevated in Breast Cancer Patients and Associate with Disease Outcome. Int J Mol Sci 2024; 25:4126. [PMID: 38612935 PMCID: PMC11012452 DOI: 10.3390/ijms25074126] [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: 03/08/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Ligands of the natural killer group 2D (NKG2DL) family are expressed on malignant cells and are usually absent from healthy tissues. Recognition of NKG2DLs such as MICA/B and ULBP1-3 by the activating immunoreceptor NKG2D, expressed by NK and cytotoxic T cells, stimulates anti-tumor immunity in breast cancer. Upregulation of membrane-bound NKG2DLs in breast cancer has been demonstrated by immunohistochemistry. Tumor cells release NKG2DLs via proteolytic cleavage as soluble (s)NKG2DLs, which allows for effective immune escape and is associated with poor prognosis. In this study, we collected serum from 140 breast cancer (BC) and 20 ductal carcinoma in situ (DCIS) patients at the time of initial diagnosis and 20 healthy volunteers (HVs). Serum levels of sNKG2DLs were quantified through the use of ELISA and correlated with clinical data. The analyzed sNKG2DLs were low to absent in HVs and significantly higher in BC patients. For some of the ligands analyzed, higher sNKG2DLs serum levels were associated with the classification of malignant tumor (TNM) stage and grading. Low sMICA serum levels were associated with significantly longer progression-free (PFS) and overall survival (OS). In conclusion, we provide the first insights into sNKG2DLs in BC patients and suggest their potential role in tumor immune escape in breast cancer. Furthermore, our observations suggest that serum sMICA levels may serve as a prognostic parameter in the patients analyzed in this study.
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Affiliation(s)
- Anna Seller
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
| | - Christian M. Tegeler
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
- Department of Peptide-Based Immunotherapy, Institute of Immunology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Jonas Mauermann
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
| | - Tatjana Schreiber
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
| | - Ilona Hagelstein
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
| | - Kai Liebel
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
| | - André Koch
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Jonas S. Heitmann
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
- Department of Peptide-Based Immunotherapy, Institute of Immunology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Sarah M. Greiner
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Clara Hayn
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
| | - Dominik Dannehl
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Tobias Engler
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Andreas D. Hartkopf
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Markus Hahn
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Sara Y. Brucker
- Department of Women’s Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Helmut R. Salih
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
| | - Melanie Märklin
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany; (A.S.)
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Röntgenweg 11, 72076 Tübingen, Germany
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Caro C, Florek A, Hahn M, Marx M. Color Doppler Sonography Assisted Subcutaneous Mastectomy with Inferior Pedicled Nipple-Areola Complex in Female-to-Male Transsexuals: A Retrospective Cohort Analysis. Aesthetic Plast Surg 2024; 48:1126-1132. [PMID: 35701593 DOI: 10.1007/s00266-022-02945-0] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The surgical goals of gender reassignment surgery of the breast in female-to male transsexuals (FMT) is the aesthetic shaping of a male thoracic wall with minimal scarring, while preserving the sensitivity of the nipple-areola complex (NAC). For large and ptotic breasts, we perform a mastectomy over an inframammary access with inferior pedicled NAC under color Doppler visualization of the perforators. This paper presents the technique, including complications and assessment of quality of life, as part of a unicentric analysis. METHODS This was a retrospective analysis of 23 patients (46 mastectomies) performed between September 2014 and September 2020. The complication rate and the number of corrective surgeries were recorded for quality assessment. A semiquantitative score was used to evaluate aesthetic outcome, nipple sensitivity, quality of life, and sexuality. RESULTS A total of 46 mastectomies were performed in 23 patients. The patient survey showed high patient satisfaction. Loss of nipple sensitivity was observed after one mastectomy (2.17%). In 91.67% of cases, patients reported that their appearance reflected how they feel on the inside. In 75% of cases, patients reported feeling equal to other men. The overall complication rate was 10.87%. Shape correction due to persistent excess of volume was rare (2.17%, equivalent to one mastectomy). CONCLUSION Subcutaneous mastectomy with inferior nipple pedicle can be performed with a high degree of safety and satisfaction in FMT. Color Doppler-guided visualization of the perforator vessels is helpful in allowing a thin pedicle preparation, thus reducing the need for secondary surgeries to optimize the shape. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- C Caro
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Heinrich-Zille-Str. 13, 01445, Radebeul, Germany.
| | - A Florek
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Heinrich-Zille-Str. 13, 01445, Radebeul, Germany
| | - M Hahn
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - M Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Heinrich-Zille-Str. 13, 01445, Radebeul, Germany
- Department of Women's Health, University of Tübingen, Tübingen, Germany
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6
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Guergan S, Boeer B, Fugunt R, Helms G, Roehm C, Solomianik A, Neugebauer A, Nuessle D, Schuermann M, Brunecker K, Jurjut O, Boehme KA, Dammeier S, Enderle MD, Bettio S, Gonzalez-Menendez I, Staebler A, Brucker SY, Kraemer B, Wallwiener D, Fend F, Hahn M. Optical Emission Spectroscopy for the Real-Time Identification of Malignant Breast Tissue. Diagnostics (Basel) 2024; 14:338. [PMID: 38337854 PMCID: PMC10855719 DOI: 10.3390/diagnostics14030338] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Breast conserving resection with free margins is the gold standard treatment for early breast cancer recommended by guidelines worldwide. Therefore, reliable discrimination between normal and malignant tissue at the resection margins is essential. In this study, normal and abnormal tissue samples from breast cancer patients were characterized ex vivo by optical emission spectroscopy (OES) based on ionized atoms and molecules generated during electrosurgical treatment. The aim of the study was to determine spectroscopic features which are typical for healthy and neoplastic breast tissue allowing for future real-time tissue differentiation and margin assessment during breast cancer surgery. A total of 972 spectra generated by electrosurgical sparking on normal and abnormal tissue were used for support vector classifier (SVC) training. Specific spectroscopic features were selected for the classification of tissues in the included breast cancer patients. The average classification accuracy for all patients was 96.9%. Normal and abnormal breast tissue could be differentiated with a mean sensitivity of 94.8%, a specificity of 99.0%, a positive predictive value (PPV) of 99.1% and a negative predictive value (NPV) of 96.1%. For 66.6% patients all classifications reached 100%. Based on this convincing data, a future clinical application of OES-based tissue differentiation in breast cancer surgery seems to be feasible.
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Affiliation(s)
- Selin Guergan
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Bettina Boeer
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Regina Fugunt
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Gisela Helms
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Carmen Roehm
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Anna Solomianik
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Alexander Neugebauer
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Daniela Nuessle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Mirjam Schuermann
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Ovidiu Jurjut
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Karen A. Boehme
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Sascha Dammeier
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Markus D. Enderle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072 Tübingen, Germany; (A.N.); (D.N.); (M.S.); (O.J.); (K.A.B.); (S.D.); (M.D.E.)
| | - Sabrina Bettio
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Irene Gonzalez-Menendez
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Annette Staebler
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Sara Y. Brucker
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Bernhard Kraemer
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Diethelm Wallwiener
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
| | - Falko Fend
- Institute of Pathology and Neuropathology, Tuebingen University Hospital, 72076 Tübingen, Germany; (S.B.); (I.G.-M.); (A.S.); (F.F.)
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University Hospital, 72076 Tübingen, Germany; (B.B.); (R.F.); (G.H.); (C.R.); (A.S.); (S.Y.B.); (B.K.); (D.W.); (M.H.)
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Thiruchelvam N, Landauro MH, Biardeau X, Rovsing C, Hahn M, Nascimento OFD, Gardner S, Amarenco G, Bagi P. Improved emptying performance with a new micro-hole zone catheter in adult male intermittent catheter users: A comparative multi-center randomized controlled cross-over study. Neurourol Urodyn 2024; 43:464-478. [PMID: 38196237 DOI: 10.1002/nau.25383] [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: 07/13/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
AIMS To confirm the improved performance of the micro-hole zone catheter (MHZC) compared to a conventional eyelet catheter (CEC) in male users of clean intermittent catheterizations (CICs). METHODS Male self-catheterizing subjects, who used hydrophilic sleeved soft/flexible CIC as the only bladder emptying method, were enrolled into a multi-center, randomized, cross-over study performed across six European sites. Subjects tested the MHZC, featuring a drainage zone with 120 micro-holes and a CEC with two eyelets. The study consisted of four study visits (V0-V3), during which endpoints related to catheter performance (urinary flow-stops, bladder emptying, and intra-catheter pressure) were measured and two 4-week test periods at home (T1 and T2) where dipstick hematuria and user perception between catheters were evaluated. RESULTS Seventy-three male subjects with non-neurogenic and neurogenic bladder dysfunction (3:2) were enrolled. On average, catheterizations with the MHZC led to close to mean zero flow-stops compared to ≥1 flow-stops with the CEC, during both HCP- and self-led catheterizations (both p < 0.001). Residual urine at first flow-stop was significantly reduced for the MHZC compared to CEC (p = 0.001 and p = 0.004, for HCP- and self-led catheterizations, respectively). This was substantiated by a significantly smaller pressure peak at first flow-stop, a proxy for minimized mucosal suction (both HCP- and self-led catheterizations, p < 0.001). After home-use catheterizations, dipstick hematuria was comparable between catheters, whereas catheterizations were associated with significantly improved perception in favor of MHZC regarding bladder emptying, less blocking sensation, and improved hygienic catheterization compared to the CEC. CONCLUSION This study confirmed the evidence of improved bladder emptying with the MHZC compared to a CEC without the need to reposition the catheter. The MHZC therefore offers an enhanced benefit for the dependent CIC user securing complete bladder emptying in an uninterrupted free flow and reducing the need to reposition the catheter during emptying.
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Affiliation(s)
- Nikesh Thiruchelvam
- Department of Urology, NHS Foundation Trust, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
| | | | - Xavier Biardeau
- Centre Hospitalier Universitaire de Lille, Lille Cedex, France
| | | | - Markus Hahn
- ARTIMED Medical Consulting GmbH, Kassel, Germany
| | | | | | | | - Per Bagi
- Department of Urology, Rigshospitalet, København Ø, Denmark
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8
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Pfob A, Cai L, Schneeweiss A, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, van Mackelenbergh M, Banys-Paluchowski M, Große R, Reinisch M, Karsten MM, Sidey-Gibbons C, Wallwiener M, Golatta M, Heil J. Minimally Invasive Breast Biopsy After Neoadjuvant Systemic Treatment to Identify Breast Cancer Patients with Residual Disease for Extended Neoadjuvant Treatment: A New Concept. Ann Surg Oncol 2024; 31:957-965. [PMID: 37947974 PMCID: PMC10761434 DOI: 10.1245/s10434-023-14551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Breast cancer patients with residual disease after neoadjuvant systemic treatment (NAST) have a worse prognosis compared with those achieving a pathologic complete response (pCR). Earlier identification of these patients might allow timely, extended neoadjuvant treatment strategies. We explored the feasibility of a vacuum-assisted biopsy (VAB) after NAST to identify patients with residual disease (ypT+ or ypN+) prior to surgery. METHODS We used data from a multicenter trial, collected at 21 study sites (NCT02948764). The trial included women with cT1-3, cN0/+ breast cancer undergoing routine post-neoadjuvant imaging (ultrasound, MRI, mammography) and VAB prior to surgery. We compared the findings of VAB and routine imaging with the histopathologic evaluation of the surgical specimen. RESULTS Of 398 patients, 34 patients with missing ypN status and 127 patients with luminal tumors were excluded. Among the remaining 237 patients, tumor cells in the VAB indicated a surgical non-pCR in all patients (73/73, positive predictive value [PPV] 100%), whereas PPV of routine imaging after NAST was 56.0% (75/134). Sensitivity of the VAB was 72.3% (73/101), and 74.3% for sensitivity of imaging (75/101). CONCLUSION Residual cancer found in a VAB specimen after NAST always corresponds to non-pCR. Residual cancer assumed on routine imaging after NAST corresponds to actual residual cancer in about half of patients. Response assessment by VAB is not safe for the exclusion of residual cancer. Response assessment by biopsies after NAST may allow studying the new concept of extended neoadjuvant treatment for patients with residual disease in future trials.
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Affiliation(s)
- André Pfob
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
- MD Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany.
| | - Lie Cai
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tübingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Medical Faculty, Breast Cancer Center, University of Cologne, Cologne, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Sylvie Joos
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - Stefan Paepke
- Frauenklinik, Interdisziplinäres Brustzentrum des Klinikums rechts der Isar der Technischen Universität München, Munich, Germany
| | - Tom Degenhardt
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
| | - Joachim Rom
- Department of Gynecology/Breast Unit, Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | | | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - 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, TX, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Michael Golatta
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
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9
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Pfob A, Cai L, Schneeweiss A, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, van Mackelenbergh M, Banys-Paluchowski M, Große R, Reinisch M, Karsten MM, Sidey-Gibbons C, Wallwiener M, Golatta M, Heil J. ASO Visual Abstract: Minimally-Invasive Breast Biopsy After Neoadjuvant Systemic Treatment to Identify Breast Cancer Patients with Residual Disease for Extended Neoadjuvant Treatment-A New Concept. Ann Surg Oncol 2024; 31:1033-1034. [PMID: 38093166 DOI: 10.1245/s10434-023-14747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- André Pfob
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany.
- Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany.
| | - Lie Cai
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sherko Kuemmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Breast Cancer Center, Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Sylvie Joos
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - Stefan Paepke
- Frauenklinik, Interdisziplinäres Brustzentrum des Klinikums rechts der Isar der Technischen Universität München, Munich, Germany
| | - Tom Degenhardt
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
| | - Joachim Rom
- Department of Gynecology/Breast Unit, Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | | | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Chris Sidey-Gibbons
- Anderson Center for INSPiRED Cancer Care (Integrated Systems for Patient-Reported Data), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Golatta
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
| | - Joerg Heil
- Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Klinikum Sankt Elisabeth, Heidelberg, Germany
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10
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Yang Q, Deng S, Preibsch H, Schade T, Koch A, Berezhnoy G, Zizmare L, Fischer A, Gückel B, Staebler A, Hartkopf AD, Pichler BJ, la Fougère C, Hahn M, Bonzheim I, Nikolaou K, Trautwein C. Image-guided metabolomics and transcriptomics reveal tumour heterogeneity in luminal A and B human breast cancer beyond glucose tracer uptake. Clin Transl Med 2024; 14:e1550. [PMID: 38332687 PMCID: PMC10853679 DOI: 10.1002/ctm2.1550] [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: 08/29/2023] [Revised: 12/28/2023] [Accepted: 01/06/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Breast cancer is a metabolically heterogeneous disease, and although the concept of heterogeneous cancer metabolism is known, its precise role in human breast cancer is yet to be fully elucidated. METHODS We investigated in an explorative approach a cohort of 42 primary mamma carcinoma patients with positron emission tomography/magnetic resonance imaging (PET/MR) prior to surgery, followed by histopathology and molecular diagnosis. From a subset of patients, which showed high metabolic heterogeneity based on tracer uptake and pathology classification, tumour centre and periphery specimen tissue samples were further investigated by a targeted breast cancer gene expression panel and quantitative metabolomics by nuclear magnetic resonance (NMR) spectroscopy. All data were analysed in a combinatory approach. RESULTS [18 F]FDG (2-deoxy-2-[fluorine-18]fluoro-d-glucose) tracer uptake confirmed dominance of glucose metabolism in the breast tumour centre, with lower levels in the periphery. Additionally, we observed differences in lipid and proliferation related genes between luminal A and B subtypes in the centre and periphery. Tumour periphery showed elevated acetate levels and enrichment in lipid metabolic pathways genes especially in luminal B. Furthermore, serine was increased in the periphery and higher expression of thymidylate synthase (TYMS) indicated one-carbon metabolism increased in tumour periphery. The overall metabolic activity based on [18 F]FDG uptake of luminal B subtype was higher than that of luminal A and the difference between the periphery and centre increased with tumour grade. CONCLUSION Our analysis indicates variations in metabolism among different breast cancer subtypes and sampling locations which details the heterogeneity of the breast tumours. Correlation analysis of [18 F]FDG tracer uptake, transcriptome and tumour metabolites like acetate and serine facilitate the search for new candidates for metabolic tracers and permit distinguishing luminal A and B. This knowledge may help to differentiate subtypes preclinically or to provide patients guide for neoadjuvant therapy and optimised surgical protocols based on individual tumour metabolism.
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Affiliation(s)
- Qianlu Yang
- Department of Preclinical Imaging and RadiopharmacyWerner Siemens Imaging CenterUniversity Hospital TuebingenTuebingenGermany
| | - Sisi Deng
- Department of Preclinical Imaging and RadiopharmacyWerner Siemens Imaging CenterUniversity Hospital TuebingenTuebingenGermany
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”University of TuebingenTuebingenGermany
| | - Heike Preibsch
- Department of Diagnostic and Interventional RadiologyUniversity Hospital TuebingenTuebingenGermany
| | - Tim‐Colin Schade
- Department of Pathology and NeuropathologyUniversity Hospital TuebingenTuebingenGermany
| | - André Koch
- Department of Women's HealthUniversity Hospital TuebingenTuebingenGermany
| | - Georgy Berezhnoy
- Department of Preclinical Imaging and RadiopharmacyWerner Siemens Imaging CenterUniversity Hospital TuebingenTuebingenGermany
| | - Laimdota Zizmare
- Department of Preclinical Imaging and RadiopharmacyWerner Siemens Imaging CenterUniversity Hospital TuebingenTuebingenGermany
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”University of TuebingenTuebingenGermany
| | - Anna Fischer
- Department of Pathology and NeuropathologyUniversity Hospital TuebingenTuebingenGermany
| | - Brigitte Gückel
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”University of TuebingenTuebingenGermany
- Department of Diagnostic and Interventional RadiologyUniversity Hospital TuebingenTuebingenGermany
| | - Annette Staebler
- Department of Pathology and NeuropathologyUniversity Hospital TuebingenTuebingenGermany
| | | | - Bernd J. Pichler
- Department of Preclinical Imaging and RadiopharmacyWerner Siemens Imaging CenterUniversity Hospital TuebingenTuebingenGermany
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”University of TuebingenTuebingenGermany
- German Cancer Research CenterGerman Cancer Consortium DKTKPartner Site TuebingenTuebingenGermany
| | - Christian la Fougère
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”University of TuebingenTuebingenGermany
- German Cancer Research CenterGerman Cancer Consortium DKTKPartner Site TuebingenTuebingenGermany
- Department of Nuclear Medicine and Clinical Molecular ImagingUniversity Hospital TuebingenTuebingenGermany
| | - Markus Hahn
- Department of Women's HealthUniversity Hospital TuebingenTuebingenGermany
| | - Irina Bonzheim
- Department of Pathology and NeuropathologyUniversity Hospital TuebingenTuebingenGermany
| | - Konstantin Nikolaou
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”University of TuebingenTuebingenGermany
- Department of Diagnostic and Interventional RadiologyUniversity Hospital TuebingenTuebingenGermany
- German Cancer Research CenterGerman Cancer Consortium DKTKPartner Site TuebingenTuebingenGermany
| | - Christoph Trautwein
- Department of Preclinical Imaging and RadiopharmacyWerner Siemens Imaging CenterUniversity Hospital TuebingenTuebingenGermany
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”University of TuebingenTuebingenGermany
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11
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Schäffler H, Mergel F, Pfister K, Lukac S, Fink A, Veselinovic K, Rack B, Fink V, Leinert E, Dimpfl M, Englisch A, Tegeler CM, Seller A, Grischke EM, Hahn M, Volmer LL, Engler T, Frevert ML, Taran FA, Janni W, Brucker SY, Hartkopf AD, Dannehl D. The Clinical Relevance of the NATALEE Study: Application of the NATALEE Criteria to a Real-World Cohort from Two Large German Breast Cancer Centers. Int J Mol Sci 2023; 24:16366. [PMID: 38003555 PMCID: PMC10671738 DOI: 10.3390/ijms242216366] [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: 09/29/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
The NATALEE study showed a significant benefit in invasive disease-free survival (iDFS) for patients with HR+/HER2- early breast cancer (eBC) at intermediate and high risk of recurrence who were treated with the CDK4/6 inhibitor Ribociclib in combination with endocrine therapy (ET). This retrospective study aims to apply the NATALEE inclusion criteria to a representative real-world cohort to estimate the proportion of HR+/HER2- breast cancer patients eligible for adjuvant Ribociclib therapy. Patients who underwent full surgical treatment for eBC between January 2018 and December 2020 at two large German university breast cancer centers (University of Ulm, University of Tuebingen) were included. Descriptive statistics were used to characterize the patient population eligible for Ribociclib treatment based on the NATALEE study's inclusion criteria. Out of 2384 enrolled patients, 1738 had HR+/HER2- eBC, of whom 43% (747/1738) met the NATALEE inclusion criteria. Of note, these patients were older, received less chemotherapy and presented with less advanced tumor stages compared to the NATALEE study cohort. Additionally, compared to the NATALEE study cohort, fewer patients had lymph node involvement (72.4% vs. 88.7%). Our analysis suggests that approximately 43% of all HR+/HER2- breast cancer patients will qualify for Ribociclib treatment. Given the numerous treatment options for patients with HR+/HER2- eBC, as well as the differences between the NATALEE cohort and patients in the real-world clinical setting, future analyses will be needed to determine which patients would benefit most from adjuvant CDK4/6 inhibitor treatment.
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Affiliation(s)
- Henning Schäffler
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Franziska Mergel
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Stephan Lukac
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Angelina Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Moritz Dimpfl
- Department of Gynecology and Obstetrics, University Hospital Mannheim, 68135 Mannheim, Germany;
| | - Alexander Englisch
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Christian Martin Tegeler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Anna Seller
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Eva-Maria Grischke
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Léa Louise Volmer
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Tobias Engler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Marie Louise Frevert
- Department of Obstetrics and Gynecology, University of Freiburg, 79106 Freiburg, Germany; (M.L.F.)
| | - Florin Andrei Taran
- Department of Obstetrics and Gynecology, University of Freiburg, 79106 Freiburg, Germany; (M.L.F.)
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Andreas Daniel Hartkopf
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89075 Ulm, Germany; (F.M.); (A.F.); (E.L.); (W.J.)
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
| | - Dominik Dannehl
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany; (A.E.); (C.M.T.); (A.S.); (E.-M.G.); (M.H.); (L.L.V.); (T.E.); (A.D.H.); (D.D.)
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12
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Volmer LL, Dannehl D, Engler T, Hahn M, Walter CB, Wallwiener M, Brucker SY, Taran FA, Hartkopf AD. Association between 21-gene-assay and detection of disseminated tumor cells in patients with early breast cancer: results from the IRMA trial. Breast Cancer Res Treat 2023; 202:67-72. [PMID: 37556015 PMCID: PMC10504215 DOI: 10.1007/s10549-023-07031-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: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Disseminated tumor cells (DTCs) in the bone marrow (BM) are known to be of prognostic value for patients with early breast cancer (EBC). In addition to histopathological features, multigene expression assays, such as the commercially available 21-gene Breast Recurrence Score® assay, have been validated for evaluating prognosis and making decisions concerning adjuvant treatment in EBC. In a previous retrospective study from our group, the 21-gene assay was shown to be associated with DTC-detection. A secondary endpoint of the prospective IRMA trial was to evaluate the association between Recurrence Score® (RS) result and tumor cell dissemination in patients with EBC. METHODS DTC-status and RS result were assessed in patients with ER-positive/HER2-negative EBC with 0-3 pathologic lymph nodes who underwent primary surgical treatment at the Department for Women's Health of Tuebingen University, Germany. RESULTS Patients with a high RS result (≥ 26) were more frequently DTC-positive (22.6%) than patients with a low RS result (8.6%, p = 0.034). The odds for DTC-positivity increased with rising RS values (p = 0.047). CONCLUSION We therefore confirm that a high genomic risk is associated with tumor cell dissemination into the BM. Further trials are needed to investigate whether therapeutic decisions could be further individualized by combining DTC-status and prognostic gene signature testing.
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Affiliation(s)
- Léa L Volmer
- Department for Women's Health, University Medical Center Tübingen, 72076, Tübingen, Germany.
| | - Dominik Dannehl
- Department for Women's Health, University Medical Center Tübingen, 72076, Tübingen, Germany
| | - Tobias Engler
- Department for Women's Health, University Medical Center Tübingen, 72076, Tübingen, Germany
| | - Markus Hahn
- Department for Women's Health, University Medical Center Tübingen, 72076, Tübingen, Germany
| | - Christina B Walter
- Department for Women's Health, University Medical Center Tübingen, 72076, Tübingen, Germany
| | - Markus Wallwiener
- Department for Gynecology and Obstetrics, University Medical Center Heidelberg, 69120, Heidelberg, Germany
| | - Sara Y Brucker
- Department for Women's Health, University Medical Center Tübingen, 72076, Tübingen, Germany
| | - Florin-Andrei Taran
- Department for Gynecology and Obstetrics, Freiburg University, 79085, Freiburg, Germany
| | - Andreas D Hartkopf
- Department for Women's Health, University Medical Center Tübingen, 72076, Tübingen, Germany
- Department for Gynecology and Obstetrics, Ulm University, 89081, Ulm, Germany
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13
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Stuhec M, Hahn M, Taskova I, Bayraktar I, Fitzgerald I, Molitschnig L, Tatarević A, Lindner N, Agnoletto L, da Costa FA. Clinical pharmacy services in mental health in Europe: a commentary paper of the European Society of Clinical Pharmacy Special Interest Group on Mental Health. Int J Clin Pharm 2023; 45:1286-1292. [PMID: 37755642 PMCID: PMC10600282 DOI: 10.1007/s11096-023-01643-4] [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: 05/29/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Abstract
A large proportion of the world's disease burden is attributable to mental illnesses. Although effective interventions are available, many patients still have limited access to evidence-based treatments. Aside from access, treatment gaps, including inappropriate medication selection and monitoring, are also routinely recognised. Mental health clinical pharmacists can help address these gaps and enable patients to receive optimised pharmaceutical care, particularly appropriate medication selection and monitoring. The European Society of Clinical Pharmacy (ESCP) Special Interest Group on Mental Health was established to improve standardised service provision in mental health settings across Europe. The Special Interest Group identified significant barriers (predominantly associated with reimbursement and position within the multidisciplinary team) to effective pharmaceutical care amongst those with mental illnesses. This commentary presents recommendations to address these gaps through improved mental health clinical pharmacy service provision.
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Affiliation(s)
- Matej Stuhec
- Department of Pharmacology, Faculty of Medicine Maribor, University of Maribor, Maribor, Slovenia.
- Department of Clinical Pharmacy, Ormoz Psychiatric Hospital, Ormoz, Slovenia.
| | - M Hahn
- Department of Mental Health, Varisano Hospital Frankfurt Hoechst, Frankfurt, Germany
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - I Taskova
- Psychiatric Hospital Bohnice, Prague, Czech Republic
- Department of Applied Pharmacy, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - I Bayraktar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - I Fitzgerald
- Pharmacy Department, St Patrick's University Hospital, Dublin 8, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - L Molitschnig
- Pharmacy Department, Hospital of Elisabethians, Graz, Austria
| | | | - N Lindner
- Pharmacy Department, Vienna General Hospital-Medical University Campus, Vienna, Austria
| | - L Agnoletto
- Hospital Pharmacy, Rovigo Hospital, Rovigo, Italy
| | - F Alves da Costa
- Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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14
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Vogel-Minea CM, Bader W, Blohmer JU, Duda V, Eichler C, Fallenberg EM, Farrokh A, Golatta M, Gruber I, Hackelöer BJ, Heil J, Madjar H, Marzotko E, Merz E, Müller-Schimpfle M, Mundinger A, Ohlinger R, Peisker U, Schäfer FK, Schulz-Wendtland R, Solbach C, Warm M, Watermann D, Wojcinski S, Dudwiesus H, Hahn M. Best Practice Guideline - DEGUM Recommendations on Breast Ultrasound. Ultraschall Med 2023; 44:520-536. [PMID: 37072031 DOI: 10.1055/a-2020-9904] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Alongside mammography, breast ultrasound is an important and well-established method in assessment of breast lesions. With the "Best Practice Guideline", the DEGUM Breast Ultrasound (in German, "Mammasonografie") working group, intends to describe the additional and optional application modalities for the diagnostic confirmation of breast findings and to express DEGUM recommendations in this Part II, in addition to the current dignity criteria and assessment categories published in Part I, in order to facilitate the differential diagnosis of ambiguous lesions.The present "Best Practice Guideline" has set itself the goal of meeting the requirements for quality assurance and ensuring quality-controlled performance of breast ultrasound. The most important aspects of quality assurance are explained in this Part II of the Best Practice Guideline.
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Affiliation(s)
- Claudia Maria Vogel-Minea
- Brustzentrum, Diagnostische und Interventionelle Senologie, Rottal-Inn Kliniken Eggenfelden, Eggenfelden, Germany
| | - Werner Bader
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Bielefeld, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Duda
- Senologische Diagnostik, Universitätsklinikum Gießen und Marburg, Marburg, Germany
| | - Christian Eichler
- Klinik für Brusterkrankungen, St Franziskus-Hospital Münster GmbH, Münster, Germany
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - André Farrokh
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Michael Golatta
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Ines Gruber
- Frauenklinik, Department für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Jörg Heil
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
- Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg, Germany
| | - Helmut Madjar
- Gynäkologie und Senologie, Praxis für Gynäkologie, Wiesbaden, Germany
| | - Ellen Marzotko
- Mammadiagnostik, Frauenheilkunde und Geburtshilfe, Praxis, Erfurt, Germany
| | - Eberhard Merz
- Frauenheilkunde, Zentrum für Ultraschall und Pränatalmedizin, Frankfurt, Germany
| | - Markus Müller-Schimpfle
- DKG-Brustzentrum, Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, varisano Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | - Alexander Mundinger
- Brustzentrum Osnabrück - Bildgebende und interventionelle Mamma Diagnostik, Franziskus Hospital Harderberg, Niels Stensen Kliniken, Georgsmarienhütte, Germany
| | - Ralf Ohlinger
- Interdisziplinäres Brustzentrum, Universitätsmedizin Greifswald, Klinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | - Uwe Peisker
- BrustCentrum Aachen-Kreis Heinsberg, Hermann-Josef Krankenhaus, Akademisches Lehrkrankenhaus der RWTH-Aachen, Erkelenz, Germany
| | - Fritz Kw Schäfer
- Bereich Mammadiagnostik und Interventionen, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Christine Solbach
- Senologie, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Mathias Warm
- Brustzentrum, Krankenhaus Holweide, Kliniken der Stadt Köln, Koeln, Germany
| | - Dirk Watermann
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Sebastian Wojcinski
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Bielefeld, Germany
| | | | - Markus Hahn
- Frauenklinik, Department für Frauengesundheit, Universität Tübingen, Tübingen, Germany
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15
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Boeer B, Helms G, Pasternak J, Roehm C, Kofler L, Haefner HM, Moehrle M, Heim E, Fischer H, Brucker SY, Hahn M. Back to the future: breast surgery with tumescent local anesthesia (TLA)? Arch Gynecol Obstet 2023; 308:935-940. [PMID: 36872392 PMCID: PMC10348980 DOI: 10.1007/s00404-023-06938-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/16/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Breast surgery is usually performed under general anesthesia. Tumescent local anesthesia (TLA) offers the possibility to anesthetize large areas with highly diluted local anesthetic. METHODS In this paper, the implementation, and experiences with TLA in the field of breast surgery are discussed. CONCLUSION For carefully selected indications, breast surgery in TLA represents an alternative to ITN.
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Affiliation(s)
- B Boeer
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
| | - G Helms
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - J Pasternak
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Roehm
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - L Kofler
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - H M Haefner
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - M Moehrle
- Praxisklinik Haut Und Venen, Tuebingen, Germany
| | - E Heim
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - H Fischer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - S Y Brucker
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - M Hahn
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
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16
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Anderle N, Schäfer-Ruoff F, Staebler A, Kersten N, Koch A, Önder C, Keller AL, Liebscher S, Hartkopf A, Hahn M, Templin M, Brucker SY, Schenke-Layland K, Schmees C. Breast cancer patient-derived microtumors resemble tumor heterogeneity and enable protein-based stratification and functional validation of individualized drug treatment. J Exp Clin Cancer Res 2023; 42:210. [PMID: 37596623 PMCID: PMC10436441 DOI: 10.1186/s13046-023-02782-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/28/2023] [Indexed: 08/20/2023] Open
Abstract
Despite tremendous progress in deciphering breast cancer at the genomic level, the pronounced intra- and intertumoral heterogeneity remains a major obstacle to the advancement of novel and more effective treatment approaches. Frequent treatment failure and the development of treatment resistance highlight the need for patient-derived tumor models that reflect the individual tumors of breast cancer patients and allow a comprehensive analyses and parallel functional validation of individualized and therapeutically targetable vulnerabilities in protein signal transduction pathways. Here, we introduce the generation and application of breast cancer patient-derived 3D microtumors (BC-PDMs). Residual fresh tumor tissue specimens were collected from n = 102 patients diagnosed with breast cancer and subjected to BC-PDM isolation. BC-PDMs retained histopathological characteristics, and extracellular matrix (ECM) components together with key protein signaling pathway signatures of the corresponding primary tumor tissue. Accordingly, BC-PDMs reflect the inter- and intratumoral heterogeneity of breast cancer and its key signal transduction properties. DigiWest®-based protein expression profiling of identified treatment responder and non-responder BC-PDMs enabled the identification of potential resistance and sensitivity markers of individual drug treatments, including markers previously associated with treatment response and yet undescribed proteins. The combination of individualized drug testing with comprehensive protein profiling analyses of BC-PDMs may provide a valuable complement for personalized treatment stratification and response prediction for breast cancer.
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Affiliation(s)
- Nicole Anderle
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany.
| | - Felix Schäfer-Ruoff
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany
| | - Annette Staebler
- Institute of Pathology and Neuropathology, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Nicolas Kersten
- Interfaculty Institute for Bioinformatics and Medical Informatics (IBMI), Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany
- FZI Research Center for Information Technology, 76131, Karlsruhe, Germany
| | - André Koch
- Department of Women's Health, University Women's Hospital, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Cansu Önder
- Department of Women's Health, University Women's Hospital, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Anna-Lena Keller
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany
| | - Simone Liebscher
- Institute of Biomedical Engineering, Department for Medical Technologies and Regenerative Medicine, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Andreas Hartkopf
- Department of Women's Health, University Women's Hospital, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- Department of Gynecology and Obstetrics, University Hospital of Ulm, 89081, Ulm, Germany
| | - Markus Hahn
- Department of Women's Health, University Women's Hospital, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Markus Templin
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Women's Hospital, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Katja Schenke-Layland
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany
- Institute of Biomedical Engineering, Department for Medical Technologies and Regenerative Medicine, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Christian Schmees
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany.
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Dannehl D, Engler T, Volmer LL, Tegeler CM, Fusshoeller J, Gabrysch E, Eissler K, Seller A, Grischke EM, Hahn M, Gruber I, Schochter F, Pfister K, Veselinovic K, Leinert E, Rack B, Fink V, Janni W, Brucker SY, Hartkopf AD, Schäffler H. Which Patients Do We Need to Test for BRCA1/2 Mutation? Feasibility of Adjuvant Olaparib Treatment in Early Breast Cancer-Real-World Data from Two Large German Breast Centers. Cancers (Basel) 2023; 15:3847. [PMID: 37568663 PMCID: PMC10417328 DOI: 10.3390/cancers15153847] [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: 06/21/2023] [Revised: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Approximately 6% of women with breast cancer carry pathogenic germline variants in predisposition genes such as BRCA1 and BRCA2. Depending on personal and family cancer history, it is therefore recommended to test for hereditary breast cancer. Moreover, as shown by the phase III OlympiA trial, olaparib significantly improves overall survival in patients with HER2 negative (HER2-) early breast cancer who (1) carry a BRCA1 or BRCA2 germline mutation (gBRCA1/2-positive), (2) have received (neo)adjuvant chemotherapy and (3) are at high clinical risk. The objective of the current analysis was to determine the number of patients with early HER2- breast cancer who are at high clinical risk, according to the inclusion criteria of OlympiA, and to estimate how many of these patients would meet the criteria for hereditary cancer testing in a real-world analysis. METHODS All patients included in this retrospective analysis were treated for early breast cancer (eBC) at the Department of Gynecology and Obstetrics, Ulm University Hospital, Germany, and the Department of Women's Health at Tuebingen University Hospital, Germany, between January 2018 and December 2020. Patients were identified as high risk, in line with the clinicopathological determiners used in the OlympiA trial. The criteria of the German Consortium for Hereditary Breast and Ovarian Cancer were used to identify patients who qualify for hereditary cancer testing. RESULTS Of 2384 eligible patients, 1738 patients (72.9%) showed a hormone receptor positive (HR+)/HER2- tumor biology, 345 patients (14.5%) displayed HER2+ breast cancer and 301 patients (12.6%) suffered from HR-/HER2- breast cancer (TNBC). Of 2039 HER2- breast cancer patients, 271 patients (13.3%) were at high clinical risk. This cohort encompassed 130 of the 1738 patients with HR+/HER2- breast cancer (7.5%) and 141 of 301 patients with TNBC (46.8%). A total of 121 of 271 patients (44.6%) with high clinical risk met the criteria for hereditary cancer testing (34 of 130 (26.2%) HR+/HER2- patients and 87 of 141 (61.7%) patients with TNBC). CONCLUSION Approximately one in ten patients with HR+/HER2-, and half of the patients with TNBC, meet the high-risk criteria according to OlympiA. Half of these patients do not meet the criteria for hereditary cancer testing and should therefore be tested for the presence of gBRCA1/2 mutations, irrespective of their own or family cancer history. The overall number of patients with early breast cancer benefiting from olaparib needs to be investigated in future studies.
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Affiliation(s)
- Dominik Dannehl
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Tobias Engler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Léa Louise Volmer
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | | | - Julia Fusshoeller
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Emma Gabrysch
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Kenneth Eissler
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Anna Seller
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Eva-Maria Grischke
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Markus Hahn
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Ines Gruber
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
| | - Andreas Daniel Hartkopf
- Department of Women’s Health, Tuebingen University, 72076 Tuebingen, Germany
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
| | - Henning Schäffler
- Department of Gynecology and Obstetrics, University Hospital, 89075 Ulm, Germany (H.S.)
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18
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Matovina S, Engler T, Volmer LL, Müller H, Grischke EM, Staebler A, Hahn M, Brucker SY, Hartkopf AD. Comparison of Biosimilar Trastuzumab ABP 980 with Reference Trastuzumab in Neoadjuvant Therapy for HER2-positive Breast Cancer - an Analysis of a Large University Breast Cancer Centre. Geburtshilfe Frauenheilkd 2023; 83:694-701. [PMID: 37614685 PMCID: PMC10442908 DOI: 10.1055/a-1963-7511] [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: 07/16/2022] [Accepted: 10/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background ABP 980 is a biosimilar antibody to reference trastuzumab (RTZ). Aim of the following study is to confirm the similarity of ABP 980 and RTZ in terms of clinical efficacy and safety in patients with HER2-positive early breast cancer (EBC) undergoing neoadjuvant trastuzumab-containing chemotherapy in a clinical real-world situation that also includes patients receiving pertuzumab. Methods Patients with HER2-positive EBC, who were treated from 12/2010 to 03/2020 at the Department of Women's Health at Tuebingen University Hospital, Germany, with at least four cycles of neoadjuvant chemotherapy (+/- pertuzumab) in combination with ABP 980 or RTZ were included in a retrospective analysis. For efficacy analysis patients achieving a pathologic complete remission (pCR = no invasive tumor in breast and lymph nodes) were compared. Safety was evaluated by comparing the number of patients with a decrease in left ventricular function (LVEF) of > 10%. Results 124 patients were included of whom 46 (37.1%) have received ABP 980 and 77 (62.9%) were treated with RTZ. A pCR was found in 77 patients (62.1%). For patients treated with ABP 980 as compared to RTZ, there was no significant difference regarding efficacy (pCR-rates of 60.9% versus 62.8%, p = 0.829) or cardiac safety (LVEF decline in 6.5% versus 2.6%, p = 0.274). Conclusion Similarity of ABP 980 as compared to RTZ was confirmed in a real-world situation, including a large proportion of patients that have also received pertuzumab treatment.
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Affiliation(s)
- Sabine Matovina
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - Lea-Louise Volmer
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - Heike Müller
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | | | - Annette Staebler
- Institute of Pathology, Tübingen University Hospital, Tübingen, Germany
| | - Markus Hahn
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | | | - Andreas Daniel Hartkopf
- Department of Women's Health, University of Tübingen, Tübingen, Germany
- Department of Gynecology and Obstetrics, University Hospital of Ulm, Ulm, Germany
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19
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Dannehl D, Dijkstra T, Gutsfeld R, Au AV, Volmer L, Engler T, Hahn M, Hawighorst-Knapstein S, Chaudhuri A, Wallwiener M, Bauer A, Brucker S, Wallwiener S, Hartkopf A. P010 Retrospective modeling of adherence to endocrine therapy in early breast cancer using real-world claims data. Breast 2023. [DOI: 10.1016/s0960-9776(23)00129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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20
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Gröschel S, Uphaus T, Gröschel K, Hahn M. P-100 Delirium in patients with acute cerebrovascular disease during visitation restrictions due to COVID-19 pandemic: A stroke-unit perspective. Clin Neurophysiol 2023. [PMCID: PMC9988268 DOI: 10.1016/j.clinph.2023.02.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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21
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Golatta M, Pfob A, Büsch C, Bruckner T, Alwafai Z, Balleyguier C, Clevert DA, Duda V, Goncalo M, Gruber I, Hahn M, Kapetas P, Ohlinger R, Rutten M, Tozaki M, Wojcinski S, Rauch G, Heil J, Barr RG. The Potential of Shear Wave Elastography to Reduce Unnecessary Biopsies in Breast Cancer Diagnosis: An International, Diagnostic, Multicenter Trial. Ultraschall Med 2023; 44:162-168. [PMID: 34425600 DOI: 10.1055/a-1543-6156] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE In this prospective, multicenter trial we evaluated whether additional shear wave elastography (SWE) for patients with BI-RADS 3 or 4 lesions on breast ultrasound could further refine the assessment with B-mode breast ultrasound for breast cancer diagnosis. MATERIALS AND METHODS We analyzed prospective, multicenter, international data from 1288 women with breast lesions rated by conventional 2 D B-mode ultrasound as BI-RADS 3 to 4c and undergoing 2D-SWE. After reclassification with SWE the proportion of undetected malignancies should be < 2 %. All patients underwent histopathologic evaluation (reference standard). RESULTS Histopathologic evaluation showed malignancy in 368 of 1288 lesions (28.6 %). The assessment with B-mode breast ultrasound resulted in 1.39 % (6 of 431) undetected malignancies (malignant lesions in BI-RADS 3) and 53.80 % (495 of 920) unnecessary biopsies (biopsies in benign lesions). Re-classifying BI-RADS 4a patients with a SWE cutoff of 2.55 m/s resulted in 1.98 % (11 of 556) undetected malignancies and a reduction of 24.24 % (375 vs. 495) of unnecessary biopsies. CONCLUSION A SWE value below 2.55 m/s for BI-RADS 4a lesions could be used to downstage these lesions to follow-up, and therefore reduce the number of unnecessary biopsies by 24.24 %. However, this would come at the expense of some additionally missed cancers compared to B-mode breast ultrasound (rate of undetected malignancies 1.98 %, 11 of 556, versus 1.39 %, 6 of 431) which would, however, still be in line with the ACR BI-RADS 3 definition (< 2 % of undetected malignancies).
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Affiliation(s)
- Michael Golatta
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Germany
| | - André Pfob
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, 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
| | - Zaher Alwafai
- Department of Gynecology and Obstetrics, University of Greifswald, Germany
| | | | - Dirk-André Clevert
- Department of Clinical Radiology, University Hospital Munich Campus Großhadern, München, Germany
| | - Volker Duda
- Department of Gynecology and Obstetrics, University of Marburg, Germany
| | | | - Ines Gruber
- Department of Gynecology and Obstetrics, University of Tübingen, Germany
| | - Markus Hahn
- Department of Gynecology and Obstetrics, University of Tübingen, Germany
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Ralf Ohlinger
- Department of Radiology, Institut Gustave-Roussy, Villejuif, France
| | - Matthieu Rutten
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
- Medical Center, Radboud University, Nijmegen, Netherlands
| | | | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Franziskus-Hospital Bielefeld, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitè University Hospital Berlin, Germany
| | - Jörg Heil
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, Germany
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Youngstown, United States
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22
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Kolberg HC, Röhm C, Stachs A, Schütz F, Blohmer JU, Wetzig S, Hartmann S, Heil J, Hahn M. Abstract P2-14-01: MOLECULAR FLUORESCENCE-GUIDED SURGERY USING BEVA800 FOR THE ASSESSMENT OF TUMOR MARGINS DURING BREAST CONSERVING SURGERY OF PATIENTS WITH PRIMARY BREAST CANCER (MARGIN-II). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-14-01] [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: 03/06/2023]
Abstract
Abstract
Introduction: The goal of breast conserving surgery (BCS) for early breast cancer (EBC) is to remove the tumor in toto and preserving as much of the normal breast tissue as possible. In 20-50% of cases a re-excision is necessary because of involved margins. Repeat surgeries are not only a burden to patients physically but also psychologically and can delay recommended adjuvant therapies. Accurate determination of tumor margins during surgery is therefore a critical need. Breast cancer tissue produces significantly higher amounts of VEGF-A than healthy tissue. VEGF-A stimulates tumor angiogenesis and is therefore a target for molecular imaging techniques. The fluorescence imaging agent bevacizumab-IRDye800CW (Beva800) is a conjugate of bevacizumab and IRDye800CW and binds specifically to VEGF-A. Beva800 provides a potentially efficacious approach to imaging specimen and cavity margins during BCS. We are presenting a phase II study that combined Beva800 with the SurgVision Explorer Air camera for intraoperative margin assessment during BCS for EBC. Methods: MARGIN II is a multicenter open-label single arm prospective clinical trial aimed at evaluating Beva800 for assessment of tumor margins in women with EBC scheduled for BCS. The study was a within-patient comparison of positive tumor margin rates using BCS standard of care margin assessment compared to intraoperative assessment with 4.5 mg Beva800 and fluorescence imaging with the SurgVision Explorer Air camera. All patients received an i.-v. bolus injection of 4.5 mg of Beva800 three days before surgery. The fluorescent signal was visualized during surgery using NIR fluorescence imaging (700–1000 nm). Standard of care margin assessment was defined as visual inspection, palpation and, in cases of pre-operative wire marking, specimen sonography or mammography. Beva800 efficacy was determined as the number of patients in which a pathology-confirmed positive margin was identified by fluorescence-guided surgery using Beva800 but not by standard of care BCS. Results: 49 patients were included in 5 centers. 4 training cases were only included in the safety analysis, 45 patients were evaluable for the efficacy analysis. 8 patients (17.8%) had involved margins after standard of care BCS, 4 of which were detected by molecular fluorescence intraoperatively resulting in the reduction of patients with positive margins by 50% (95% CI: 15.7%, 84.3%). 4 patients (8.9%; 95% CI: 2.5%, 21.1%) needed a re-excision because of involved margins. In 27 patients (60.0%) the additional molecular fluorescence guided cavity shaving did not change the resection status from positive to negative (false positive). Adverse events were reported by 16 of 49 patients (32.7%), but only 3 (6.1%) were related to Beva800 (syncope, hot flush, hypertensive crisis). One patient experienced a treatment related SAE (hypertensive crisis). No anti-Beva800 antibodies were detected. Conclusion: In our analysis the rate of necessary second operations was reduced by 50% using Beva800 and the SurgVision Explorer Air camera. The safety analysis confirmed the positive safety profile of Beva800 found in previous studies. Molecular fluorescence-guided surgery may have the potential to change the practice of breast conserving surgery by reducing unnecessary re-excisions. Future studies will have to address the high false positive rates.
Citation Format: Hans-Christian Kolberg, Carmen Röhm, Angrit Stachs, Florian Schütz, Jens-Uwe Blohmer, Sarah Wetzig, Steffi Hartmann, Jörg Heil, Markus Hahn. MOLECULAR FLUORESCENCE-GUIDED SURGERY USING BEVA800 FOR THE ASSESSMENT OF TUMOR MARGINS DURING BREAST CONSERVING SURGERY OF PATIENTS WITH PRIMARY BREAST CANCER (MARGIN-II) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-01.
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Affiliation(s)
| | | | | | | | | | | | | | - Jörg Heil
- 8Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany
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23
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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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24
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Banys-Paluchowski M, Kühn T, Masannat Y, Rubio I, de Boniface J, Ditsch N, Karadeniz Cakmak G, Karakatsanis A, Dave R, Hahn M, Potter S, Kothari A, Gentilini OD, Gulluoglu BM, Lux MP, Smidt M, Weber WP, Aktas Sezen B, Krawczyk N, Hartmann S, Di Micco R, Nietz S, Malherbe F, Cabioglu N, Canturk NZ, Gasparri ML, Murawa D, Harvey J. Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411). Cancers (Basel) 2023; 15:cancers15041173. [PMID: 36831516 PMCID: PMC9954476 DOI: 10.3390/cancers15041173] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. METHODS We performed a systematic review on localization techniques for non-palpable breast cancer. RESULTS For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons' and radiologists' attitudes towards these techniques. CONCLUSIONS Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
- Correspondence:
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Die Filderklinik, 70794 Filderstadt, Germany
| | - Yazan Masannat
- Aberdeen Breast Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Isabel Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, 28027 Madrid, Spain
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Surgery, Capio St. Göran’s Hospital, 11219 Stockholm, Sweden
| | - Nina Ditsch
- Breast Cancer Center, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Güldeniz Karadeniz Cakmak
- Breast and Endocrine Unit, General Surgery Department, Zonguldak BEUN The School of Medicine, Kozlu/Zonguldak 67600, Turkey
| | - Andreas Karakatsanis
- Department for Surgical Sciences, Faculty of Pharmacy and Medicine, Uppsala University, 75236 Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, 75236 Uppsala, Sweden
| | - Rajiv Dave
- Nightingale & Genesis Breast Cancer Prevention Centre, Manchester University NHS Foundation Trust, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Markus Hahn
- Department for Women’s Health, University of Tübingen, 72076 Tübingen, Germany
| | - Shelley Potter
- Bristol Medical School (THS), Bristol Population Health Science Institute, Bristol BS8 1QU, UK
| | - Ashutosh Kothari
- Guy’s & St Thomas NHS Foundation Trust, Kings College, London SE1 9RT, UK
| | - Oreste Davide Gentilini
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Bahadir M. Gulluoglu
- Department of Surgery, Breast Surgery Unit, Marmara University School of Medicine and SENATURK Turkish Academy of Senology, Istanbul 34854, Turkey
| | - Michael Patrick Lux
- Department of Gynecology and Obstetrics, St. Louise Frauen-und Kinderklinik, 33098 Paderborn, Germany
| | - Marjolein Smidt
- Department of Surgical Oncology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Walter Paul Weber
- Division of Breast Surgery, Department of Surgery, Basel University Hospital, 4031 Basel, Switzerland
| | - Bilge Aktas Sezen
- European Breast Cancer Research Association of Surgical Trialists (EUBREAST), 73730 Esslingen, Germany
| | - Natalia Krawczyk
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Steffi Hartmann
- Department of Gynecology and Obstetrics, University Hospital Rostock, 18059 Rostock, Germany
| | - Rosa Di Micco
- Department of Breast Surgery, San Raffaele University and Research Hospital, 20132 Milan, Italy
| | - Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Francois Malherbe
- Breast and Endocrine Surgery Unit, Groote Schuur Hospital, University of Cape Town, Cape Town 7935, South Africa
| | - Neslihan Cabioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul 34093, Turkey
| | - Nuh Zafer Canturk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli 41001, Turkey
| | - Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, 6900 Lugano, Switzerland
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale, Via Pietro Capelli 1, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Via Giuseppe Buffi 13, 6900 Lugano, Switzerland
| | - Dawid Murawa
- General Surgery and Surgical Oncology Department, Collegium Medicum, University in Zielona Gora, 65-417 Zielona Góra, Poland
| | - James Harvey
- Nightingale & Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester M13 9PL, UK
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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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Bader W, Vogel-Minea CM, Blohmer JU, Duda V, Eichler C, Fallenberg E, Farrokh A, Golatta M, Gruber I, Hackelöer BJ, Heil J, Madjar H, Marzotko E, Merz E, Müller-Schimpfle M, Mundinger A, Ohlinger R, Peisker U, Schäfer FKW, Schulz-Wendtland R, Solbach C, Warm M, Watermann D, Wojcinski S, Hahn M. Best Practice Guideline - DEGUM Recommendations on Breast Ultrasound. Ultraschall Med 2022; 43:570-582. [PMID: 34921376 DOI: 10.1055/a-1634-5021] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
For many years, breast ultrasound has been used in addition to mammography as an important method for clarifying breast findings. However, differences in the interpretation of findings continue to be problematic 1 2. These differences decrease the diagnostic accuracy of ultrasound after detection of a finding and complicate interdisciplinary communication and the comparison of scientific studies 3. In 1999, the American College of Radiology (ACR) created a working group (International Expert Working Group) that developed a classification system for ultrasound examinations based on the established BI-RADS classification of mammographic findings under consideration of literature data 4. Due to differences in content, the German Society for Ultrasound in Medicine (DEGUM) published its own BI-RADS-analogue criteria catalog in 2006 3. In addition to the persistence of differences in content, there is also an issue with formal licensing with the current 5th edition of the ACR BI-RADS catalog, even though the content is recognized by the DEGUM as another system for describing and documenting findings. The goal of the Best Practice Guideline of the Breast Ultrasound Working Group of the DEGUM is to provide colleagues specialized in senology with a current catalog of ultrasound criteria and assessment categories as well as best practice recommendations for the various ultrasound modalities.
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Affiliation(s)
- Werner Bader
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Germany
| | - Claudia Maria Vogel-Minea
- Brustzentrum, Diagnostische und Interventionelle Senologie, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Germany
| | - Volker Duda
- Senologische Diagnostik, Universitätsklinikum Gießen und Marburg, Germany
| | | | - Eva Fallenberg
- Brustzentrum, Diagnostische und Interventionelle Senologie, LMU Klinikum der Universität München Medizinische Klinik und Poliklinik IV, München, Germany
| | - André Farrokh
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Germany
| | - Michael Golatta
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Germany
| | - Ines Gruber
- Department für Frauengesundheit, Universitätsfrauenklinikum Tübingen, Germany
| | | | - Jörg Heil
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Germany
| | - Helmut Madjar
- Gynäkologie und Senologie Wiesbaden, Praxis, Wiesbaden, Germany
| | - Ellen Marzotko
- Mammadiagnostik, Frauenheilkunde und Geburtshilfe, Praxis, Erfurt, Germany
| | - Eberhard Merz
- Ultraschall und Pränatalmedizin Frankfurt, Zentrum, Frankfurt/Main, Germany
| | - Markus Müller-Schimpfle
- DKG-Brustzentrum, Klinik für Radiologie, Neuroradiologie und Nuklearmedizin Frankfurt, Frankfurt am Main, Germany
| | - Alexander Mundinger
- Brustzentrum Osnabrück - Bildgebende und interventionelle Mamma Diagnostik, Franziskus Hospital Harderberg, Niels-Stensen-Kliniken, Georgsmarienhütte, Germany
| | - Ralf Ohlinger
- Interdisziplinäres Brustzentrum, Universitätsmedizin Greifswald, Klinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | - Uwe Peisker
- BrustCentrum Aachen-Kreis Heinsberg, Hermann-Josef-Krankenhaus, Akademisches Lehrkrankenhaus der RWTH Aachen, Erkelenz, Germany
| | - Fritz K W Schäfer
- Bereich Mammadiagnostik und Interventionen, Universitätsklinikum Schleswig-Holstein Campus Kiel, Germany
| | | | - Christine Solbach
- Senologie, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Germany
| | - Mathias Warm
- Brustzentrum, Krankenhaus Holweide, Kliniken der Stadt Köln, Köln, Germany
| | - Dirk Watermann
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Sebastian Wojcinski
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Germany
| | - Markus Hahn
- Department für Frauengesundheit, Universitätsfrauenklinikum Tübingen, Germany
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Dannehl D, Engler T, Volmer LL, Staebler A, Fischer AK, Weiss M, Hahn M, Walter CB, Grischke EM, Fend F, Taran FA, Brucker SY, Hartkopf AD. Recurrence Score ® Result Impacts Treatment Decisions in Hormone Receptor-Positive, HER2-Negative Patients with Early Breast Cancer in a Real-World Setting-Results of the IRMA Trial. Cancers (Basel) 2022; 14:5365. [PMID: 36358784 PMCID: PMC9657368 DOI: 10.3390/cancers14215365] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Patients with hormone receptor-positive (HR+), HER2-negative (HER2-) early breast cancer (eBC) with a high risk of relapse often undergo adjuvant chemotherapy. However, only a few patients will gain benefit from chemotherapy. Since classical tumor characteristics (grade, tumor size, lymph node involvement, and Ki67) are of limited value to predict chemotherapy efficacy, multigene expression assays such as the Oncotype DX® test were developed to reduce over- and undertreatment. The IRMA trial analyzed the impact of Recurrence Score® (RS) assessment on adjuvant treatment recommendations. MATERIALS AND METHODS The RS result was assessed in patients with HR+/HER2- unilateral eBC with 0-3 pathologic lymph nodes who underwent primary surgical treatment at the Department for Women's Health of Tuebingen University, Germany. Therapy recommendations without knowledge of the RS result were compared to therapy recommendations with awareness of the RS result. RESULTS In total, 245 patients underwent RS assessment. Without knowledge of the RS result, 92/245 patients (37.6%) would have been advised to receive chemotherapy. After RS assessment, 56/245 patients (22.9%) were advised to undergo chemotherapy. Chemotherapy was waived in 47/92 patients (51.1%) that were initially recommended to receive it. Chemotherapy was added in 11/153 patients (7.2%) that were recommended to not receive it initially. SUMMARY Using the RS result to guide adjuvant treatment decisions in HR+/HER2- breast cancer led to a substantial reduction of chemotherapy. In view of the results achieved in prospective studies, the RS result is among other risk-factors suitable for the individualization of adjuvant systemic therapy.
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Affiliation(s)
- Dominik Dannehl
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Tobias Engler
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Lea L. Volmer
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Annette Staebler
- Department for Pathology and Neuropathology, Tuebingen University, 72076 Tübingen, Germany
| | - Anna K. Fischer
- Department for Pathology and Neuropathology, Tuebingen University, 72076 Tübingen, Germany
| | - Martin Weiss
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Markus Hahn
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Christina B. Walter
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Eva-Maria Grischke
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Falko Fend
- Department for Pathology and Neuropathology, Tuebingen University, 72076 Tübingen, Germany
| | - Florin-Andrei Taran
- Department for Gynecology and Obstetrics, Freiburg University, 79085 Freiburg im Breisgau, Germany
| | - Sara Y. Brucker
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Andreas D. Hartkopf
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
- Department for Gynecology and Obstetrics, Ulm University, 89081 Ulm, Germany
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Ruoff F, Kersten N, Anderle N, Jerbi S, Stahl A, Koch A, Staebler A, Hartkopf A, Brucker SY, Hahn M, Schenke-Layland K, Schmees C, Templin MF. Protein Profiling of Breast Carcinomas Reveals Expression of Immune-Suppressive Factors and Signatures Relevant for Patient Outcome. Cancers (Basel) 2022; 14:cancers14184542. [PMID: 36139700 PMCID: PMC9496820 DOI: 10.3390/cancers14184542] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
In cancer, the complex interplay between tumor cells and the tumor microenvironment results in the modulation of signaling processes. By assessing the expression of a multitude of proteins and protein variants in cancer tissue, wide-ranging information on signaling pathway activation and the status of the immunological landscape is obtainable and may provide viable information on the treatment response. Archived breast cancer tissues from a cohort of 84 patients (no adjuvant therapy) were analyzed by high-throughput Western blotting, and the expression of 150 proteins covering central cancer pathways and immune cell markers was examined. By assessing CD8α, CD11c, CD16 and CD68 expression, immune cell infiltration was determined and revealed a strong correlation between event-free patient survival and the infiltration of immune cells. The presence of tumor-infiltrating lymphocytes was linked to the pronounced activation of the Jak/Stat signaling pathway and apoptotic processes. The elevated phosphorylation of PPARγ (pS112) in non-immune-infiltrated tumors suggests a novel immune evasion mechanism in breast cancer characterized by increased PPARγ phosphorylation. Multiplexed immune cell marker assessment and the protein profiling of tumor tissue provide functional signaling data facilitating breast cancer patient stratification.
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Affiliation(s)
- Felix Ruoff
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770 Reutlingen, Germany
| | - Nicolas Kersten
- FZI Research Center for Information Technology, Intelligent Systems and Production Engineering (ISPE), 76131 Karlsruhe, Germany
- Interfaculty Institute for Biomedical Informatics (IBMI), University of Tuebingen, 72076 Tuebingen, Germany
| | - Nicole Anderle
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770 Reutlingen, Germany
| | - Sandra Jerbi
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770 Reutlingen, Germany
| | - Aaron Stahl
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770 Reutlingen, Germany
| | - André Koch
- Department of Women’s Health, University of Tuebingen, 72076 Tuebingen, Germany
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University of Tuebingen, 72076 Tuebingen, Germany
| | - Andreas Hartkopf
- Department of Women’s Health, University of Tuebingen, 72076 Tuebingen, Germany
- Department of Women’s Health, University of Ulm, 89081 Ulm, Germany
| | - Sara Y. Brucker
- Department of Women’s Health, University of Tuebingen, 72076 Tuebingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, 72076 Tuebingen, Germany
| | - Markus Hahn
- Department of Women’s Health, University of Tuebingen, 72076 Tuebingen, Germany
| | - Katja Schenke-Layland
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770 Reutlingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, 72076 Tuebingen, Germany
- Institute of Biomedical Engineering, Department for Medical Technologies and Regenerative Medicine, University of Tuebingen, 72076 Tuebingen, Germany
| | - Christian Schmees
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770 Reutlingen, Germany
| | - Markus F. Templin
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770 Reutlingen, Germany
- Correspondence: ; Tel.: +49-7121-51530-828
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Hahn M, Dreimann M, Matschke J, Lohner L, Püschel K. Ja, vom Lebensretter zur Gefahr – „Out of position“ macht den Unterschied. Rechtsmedizin (Berl) 2022. [DOI: 10.1007/s00194-022-00582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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30
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Hartmann S, Kühn T, Hauptmann M, Stickeler E, Thill M, Lux MP, Fröhlich S, Ruf F, Loibl S, Blohmer JU, Kolberg HC, Thiemann E, Weigel M, Solbach C, Kaltenecker G, Paluchowski P, Schrauder MG, Paepke S, Watermann D, Hahn M, Hufnagel M, Lefarth J, Untch M, Banys-Paluchowski M. Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany: Initial Data from the AXSANA study. Geburtshilfe Frauenheilkd 2022; 82:932-940. [PMID: 36110892 PMCID: PMC9470287 DOI: 10.1055/a-1889-7883] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current clinical practice in Germany. Material and Methods In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022. Results During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22% of patients. The target lymph node (TLN) was marked in 64% of cases. This was done with clips/coils in 83% of patients, with magnetic seeds or carbon suspension in 8% each, and with a radar marker in 1% of patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48% of patients, and sentinel lymph node biopsy alone (SLNB) in 2%. Clinically, the nodal status after NACT was found to be unremarkable in 65% of cases. Histological lymph node status was correctly assessed by palpation in 65% of patients and by sonography in 69% of patients. Conclusion At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether axillary dissection after NACT should be performed based on clinical assessment of nodal status alone.
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Affiliation(s)
- Steffi Hartmann
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Rostock, Rostock, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany,Correspondence/Korrespondenzadresse Prof. Dr. med. Thorsten Kühn Klinik für Frauenheilkunde und GeburtshilfeKlinikum
EsslingenHirschlandstraße 9773730 Esslingen
a. N.Germany
| | - Michael Hauptmann
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, AGAPLESION MARKUS KRANKENHAUS, Frankfurt am Main, Germany
| | - Michael P. Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, St. Vincenz Krankenhaus GmbH, Paderborn, Germany
| | - Sarah Fröhlich
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Rostock, Rostock, Germany
| | - Franziska Ruf
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany,Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Germany
| | - Jens-Uwe Blohmer
- Gynäkologie mit Brustzentrum, Charité – Universitätsmedizin, Berlin, Germany
| | | | | | - Michael Weigel
- Brustzentrum Schweinfurt-Mainfranken, Leopoldina-Krankenhaus, Schweinfurt, Germany
| | - Christine Solbach
- Klinik für Gynäkologie und Geburtshilfe, Universität Frankfurt, Brustzentrum, Frankfurt am Main, Germany
| | | | | | | | - Stefan Paepke
- Klinikum rechts der Isar, interdisziplinäres Brustzentrum, Technische Universität München, München, Germany
| | - Dirk Watermann
- Evangelisches Diakoniekrankenhaus, Brustzentrum Südbaden, Freiburg im Breisgau, Germany
| | - Markus Hahn
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Jutta Lefarth
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Memmingen, Memmingen, Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Banys-Paluchowski M, Rubio IT, Karadeniz Cakmak G, Esgueva A, Krawczyk N, Paluchowski P, Gruber I, Marx M, Brucker SY, Bündgen N, Kühn T, Rody A, Hanker L, Hahn M. Intraoperative Ultrasound-Guided Excision of Non-Palpable and Palpable Breast Cancer: Systematic Review and Meta-Analysis. Ultraschall Med 2022; 43:367-379. [PMID: 35760079 DOI: 10.1055/a-1821-8559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Wire-guided localization (WGL) is the most frequently used localization technique in non-palpable breast cancer (BC). However, low negative margin rates, patient discomfort, and the possibility of wire dislocation have been discussed as potential disadvantages, and re-operation due to positive margins may increase relapse risk. Intraoperative ultrasound (IOUS)-guided excision allows direct visualization of the lesion and the resection volume and reduces positive margins in palpable and non-palpable tumors. We performed a systematic review on IOUS in breast cancer and 2 meta-analyses of randomized clinical trials (RCTs). In non-palpable BC, 3 RCTs have shown higher negative margin rates in the IOUS arm compared to WGL. Meta-analysis confirmed a significant difference between IOUS and WGL in terms of positive margins favoring IOUS (risk ratio 4.34, p < 0.0001, I2 = 0%). 41 cohort studies including 3291 patients were identified, of which most reported higher negative margin and lower re-operation rates if IOUS was used. In palpable BC, IOUS was compared to palpation-guided excision in 3 RCTs. Meta-analysis showed significantly higher rates of positive margins in the palpation arm (risk ratio 2.84, p = 0.0047, I2 = 0%). In 13 cohort studies including 942 patients with palpable BC, negative margin rates were higher if IOUS was used, and tissue volumes were higher in palpation-guided cohorts in most studies. IOUS is a safe noninvasive technique for the localization of sonographically visible tumors that significantly improves margin rates in palpable and non-palpable BC. Surgeons should be encouraged to acquire ultrasound skills and participate in breast ultrasound training.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Isabel T Rubio
- Breast Surgical Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - Güldeniz Karadeniz Cakmak
- General Surgery Department, Breast and Endocrine Unit, Zonguldak BEUN The School of Medicine, Kozlu/Zonguldak, Turkey
| | - Antonio Esgueva
- Breast Surgical Unit, Clinica Universidad de Navarra, Madrid, Spain
| | - Natalia Krawczyk
- Department of Obstetrics and Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Peter Paluchowski
- Department of Gynecology and Obstetrics, Regio Klinikum Pinneberg, Pinneberg, Germany
| | - Ines Gruber
- Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Mario Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany
| | - Sara Y Brucker
- Department for Women's Health, University of Tübingen, Tübingen, Germany
| | - Nana Bündgen
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Achim Rody
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Lars Hanker
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Markus Hahn
- Department for Women's Health, University of Tübingen, Tübingen, Germany
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Boeer B, Seller A, Schoenfisch B, Krainick-Strobel U, Dietrich A, Brucker SY, Wallwiener D, Niess A, Hahn M. The impact of rehabilitation sport on breast cancer-related lymphoedema and quality of life. Arch Gynecol Obstet 2022; 307:1529-1537. [PMID: 35879447 PMCID: PMC10110661 DOI: 10.1007/s00404-022-06609-x] [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: 04/08/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Surgery and radiotherapy as part of breast cancer treatment can lead to lymphoedema of the upper extremities (breast cancer-related lymphoedema = BCRL) and reduce the quality of life (health-related quality of life = HRQoL). The aim of the present study was to investigate the influence of paddling in a dragon boat (PP) on HRQoL and BCRL in breast cancer survivors (BCS). METHODS Between April and October 2017, a prospective case-control study evaluated the effects of PP compared to a control group. In the paddle group (n = 28), weekly arm circumference measurements were taken at four defined anatomic areas of the arm before and after training; in the control group (n = 70), the measurements were taken once a month. At the beginning and end of the study, questionnaires from both groups (SF 36, EORTC QLQ C30) were evaluated to understand the differences in HRQoL. RESULTS The paddle group started with a higher HRQoL compared to the control group. Most interesting, whether the affected or unaffected arm, whether before or after training-the arm circumference decreased over time in the paddling group. A pre-existing lymphoedema was not negatively influenced by paddling. In the paddle group, the physical health was constant over the season, while the physical health of the control group decreased significantly over time. CONCLUSION PP in a dragon boat does not lead to the development or worsening of pre-existing lymphoedema due to breast cancer therapy, and seems to have a positive effect on the quality of life.
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Affiliation(s)
- Bettina Boeer
- Department of Women's Health, University Hospital of Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
| | - Anna Seller
- Department of Women's Health, University Hospital of Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Birgitt Schoenfisch
- Research Institute for Women's Health, University of Tuebingen, Tuebingen, Germany
| | | | - Andreas Dietrich
- Faculty of Economics and Social Sciences, Institute for Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Hospital of Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Diethelm Wallwiener
- Department of Women's Health, University Hospital of Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Andreas Niess
- Department of Sports Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Markus Hahn
- Department of Women's Health, University Hospital of Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
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Pfob A, Sidey-Gibbons C, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, van Mackelenbergh M, Banys-Paluchowski M, Große R, Reinisch M, Karsten M, Golatta M, Heil J. Intelligent Vacuum-Assisted Biopsy to Identify Breast Cancer Patients With Pathologic Complete Response (ypT0 and ypN0) After Neoadjuvant Systemic Treatment for Omission of Breast and Axillary Surgery. J Clin Oncol 2022; 40:1903-1915. [PMID: 35108029 DOI: 10.1200/jco.21.02439] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 01/05/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Neoadjuvant systemic treatment (NST) elicits a pathologic complete response in 40%-70% of women with breast cancer. These patients may not need surgery as all local tumor has already been eradicated by NST. However, nonsurgical approaches, including imaging or vacuum-assisted biopsy (VAB), were not able to accurately identify patients without residual cancer in the breast or axilla. We evaluated the feasibility of a machine learning algorithm (intelligent VAB) to identify exceptional responders to NST. METHODS We trained, tested, and validated a machine learning algorithm using patient, imaging, tumor, and VAB variables to detect residual cancer after NST (ypT+ or in situ or ypN+) before surgery. We used data from 318 women with cT1-3, cN0 or +, human epidermal growth factor receptor 2-positive, triple-negative, or high-proliferative Luminal B-like breast cancer who underwent VAB before surgery (ClinicalTrials.gov identifier: NCT02948764, RESPONDER trial). We used 10-fold cross-validation to train and test the algorithm, which was then externally validated using data of an independent trial (ClinicalTrials.gov identifier: NCT02575612). We compared findings with the histopathologic evaluation of the surgical specimen. We considered false-negative rate (FNR) and specificity to be the main outcomes. RESULTS In the development set (n = 318) and external validation set (n = 45), the intelligent VAB showed an FNR of 0.0%-5.2%, a specificity of 37.5%-40.0%, and an area under the receiver operating characteristic curve of 0.91-0.92 to detect residual cancer (ypT+ or in situ or ypN+) after NST. Spiegelhalter's Z confirmed a well-calibrated model (z score -0.746, P = .228). FNR of the intelligent VAB was lower compared with imaging after NST, VAB alone, or combinations of both. CONCLUSION An intelligent VAB algorithm can reliably exclude residual cancer after NST. The omission of breast and axillary surgery for these exceptional responders may be evaluated in future trials.
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Affiliation(s)
- André Pfob
- University Breast Unit, Department of Obstetrics & 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, TX
| | - 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, TX
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, Breast Cancer Center, Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Sylvie Joos
- Radiologische Allianz Hamburg, Hamburg, Germany
| | - Stefan Paepke
- Department of Gynecology/Breast Unit, Hospital rechts der Isar, Munich, Germany
| | - Tom Degenhardt
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
| | - Joachim Rom
- Department of Gynecology/Breast Unit, Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | - Maggie Banys-Paluchowski
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | - Maria Karsten
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Michael Golatta
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joerg Heil
- University Breast Unit, Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
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Rief A, Kühn T, Peintinger F, Hartmann S, Stickeler E, de Boniface J, Gentilini O, Ruf F, Fröhlich S, Thill M, Hauptmann M, Berger T, Wihlfahrt K, Karadeniz GC, Rubio IT, Gasparri ML, Kontos M, Bonci EA, Niinikoski L, Murawa D, Appelgren M, Hahn M, Pristauz-Telsnigg G, Czihak J, Banys-Paluchowski M. AXSANA – AXillary Surgery After NeoAdjuvant Treatment: Eine prospektive, multizentrische Kohortenstudie der EUBREAST-Studiengruppe zur Bewertung verschiedener chirurgischer Verfahren des axillären Stagings bei initial nodal-positiven PatientInnen nach neoadjuvanter Chemotherapie. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750235] [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: 10/17/2022] Open
Affiliation(s)
- A Rief
- Medizinische Universität Graz, Univ. Klinik für Frauenheilkunde und Geburtshilfe, Graz, Österreich
| | - T Kühn
- Klinikum Esslingen, Klinik für Frauenheilkunde und Geburtshilfe, Esslingen, Deutschland
| | - F Peintinger
- Medizinische Universität Graz, Univ. Klinik für Frauenheilkunde und Geburtshilfe, Graz, Österreich
| | - S Hartmann
- Universitätsklinikum Rostock, Klinik für Frauenheilkunde und Geburtshilfe, Rostock, Deutschland
| | - E Stickeler
- Universitätsklinikum Aachen, Klinik für Frauenheilkunde und Geburtshilfe, Aachen, Deutschland
| | - J de Boniface
- Karolinska Institutet, Dept. of Molecular Medicine and Surgery, Stockholm, Sweden
- Capio St. Göran’s Hospital, Dept. of Surgery, Stockholm, Sweden
| | | | - F Ruf
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe, Campus Lübeck, Lübeck, Deutschland
| | - S Fröhlich
- Universitätsklinikum Rostock, Klinik für Frauenheilkunde und Geburtshilfe, Rostock, Deutschland
| | - M Thill
- AGAPLESION Markus Krankenhaus, Klinik für Gynäkologie und gynäkologische Onkologie, Frankfurt am Main, Deutschland
| | - M Hauptmann
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - T Berger
- Müritz-Klinikum Waren, Klinik für Frauenheilkunde und Geburtshilfe, Waren, Deutschland
| | - K Wihlfahrt
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe, Campus Kiel, Kiel, Deutschland
| | - G Cakmak Karadeniz
- Zonguldak BEUN The School of Medicine, General Surgery Department, Breast and Endocrine Unit, Kozlu/Zonguldak, Turkey
| | - I T Rubio
- Clínica Universidad de Navarra, Breast Surgical Unit, Madrid, Spain
| | - M L Gasparri
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
- University of the Italian Switzerland (USI), Faculty of Biomedicine, Lugano, Switzerland
| | - M Kontos
- 1st Department of Surgery, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E-A Bonci
- Department of Surgical Oncology,” Prof. Dr. Ion Chiricuță” Institute of Oncology, Cluj-Napoca, Romania
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - L Niinikoski
- Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - D Murawa
- Department of General Surgery and Surgical Oncology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - M Appelgren
- Karolinska Institutet, Dept. of Molecular Medicine and Surgery, Stockholm, Sweden
| | - M Hahn
- Department für Frauengesundkeit, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - G Pristauz-Telsnigg
- Medizinische Universität Graz, Univ. Klinik für Frauenheilkunde und Geburtshilfe, Graz, Österreich
| | - J Czihak
- LKH Villach, Abteilung für Gynäkologie und Geburtshilfe, Villach, Österreich
| | - M Banys-Paluchowski
- Universitätsklinikum Schleswig-Holstein, Klinik für Frauenheilkunde und Geburtshilfe, Campus Lübeck, Lübeck, Deutschland
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35
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Friedrich M, Hahn M, Michel J, Sankowski R, Kilian M, Kehl N, Günter M, Bunse T, Pusch S, von Deimling A, Wick W, Autenrieth SE, Prinz M, Platten M, Bunse L. Dysfunctional dendritic cells limit antigen-specific T cell response in glioma. Neuro Oncol 2022; 25:263-276. [PMID: 35609569 PMCID: PMC9925697 DOI: 10.1093/neuonc/noac138] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dendritic cells (DC), the most potent professional antigen presenting cells capable of effective cross-presentation, have been demonstrated to license T helper cells to induce antitumor immunity in solid tumors. Specific DC subtypes are recruited to the injured brain by microglial chemokines, locally adapting to distinct transcriptional profiles. In isocitrate dehydrogenase (IDH) type 1 mutant gliomas, monocyte-derived macrophages have recently been shown to display an attenuated intratumoral antigen presentation capacity as consequence of the local accumulation of the oncometabolite R-2-hydroxyglutarate. The functionality and the contribution of DC to the IDH-mutant tumor microenvironment (TME) remains unclear. METHODS Frequencies and intratumoral phenotypes of human DC in IDH-wildtype (IDHwt) and -mutant high-grade gliomas are comparatively assessed by transcriptomic and proteomic profiling. DC functionality is investigated in experimental murine glioblastomas expressing the model antigen ovalbumin. Single-cell sequencing-based pseudotime analyses and spectral flow cytometric analyses are used to profile DC states longitudinally. RESULTS DC are present in primary and recurrent high-grade gliomas and interact with other immune cell types within the TME. In murine glioblastomas, we find an IDH-status-associated major histocompatibility class I-restricted cross-presentation of tumor antigens by DC specifically in the tumor but not in meninges or secondary lymphoid organs of tumor-bearing animals. In single-cell sequencing-based pseudotime and longitudinal spectral flow cytometric analyses, we demonstrate an IDH-status-dependent differential, exclusively microenvironmental education of DC. CONCLUSIONS Glioma-associated DCs are relevantly abundant in human IDHwt and mutant tumors. Glioma IDH mutations result in specifically educated, dysfunctional DCs via paracrine reprogramming of infiltrating monocytes, providing the basis for combinatorial immunotherapy concepts against IDH mutant gliomas.
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Affiliation(s)
- Mirco Friedrich
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Markus Hahn
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany,Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Julius Michel
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Roman Sankowski
- Department of Neuropathology, Freiburg University Hospital, Freiburg, Germany
| | - Michael Kilian
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Niklas Kehl
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manina Günter
- Dendritic Cells in Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Theresa Bunse
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Pusch
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany,DKTK Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany,DKTK Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany,DKTK Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stella E Autenrieth
- Dendritic Cells in Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Prinz
- Department of Neuropathology, Freiburg University Hospital, Freiburg, Germany
| | - Michael Platten
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,Helmholtz Institute of Translational Oncology (HI-TRON), Mainz, Germany,Immune Monitoring Unit, National Center for Tumor Diseases (NCT), Heidelberg, Germany ,DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Lukas Bunse
- Corresponding Author: Lukas Bunse, MD, PhD, German Cancer Research Center (DKFZ), Heidelberg, Germany ()
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Heil J, Pfob A, Sinn HP, Rauch G, Bach P, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Ditsch N, Rody A, Große R, van Mackelenbergh M, Reinisch M, Karsten M, Golatta M. Diagnosing Pathologic Complete Response in the Breast After Neoadjuvant Systemic Treatment of Breast Cancer Patients by Minimal Invasive Biopsy: Oral Presentation at the San Antonio Breast Cancer Symposium on Friday, December 13, 2019, Program Number GS5-03. Ann Surg 2022; 275:576-581. [PMID: 32657944 DOI: 10.1097/sla.0000000000004246] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated the ability of minimally invasive, image-guided vacuum-assisted biopsy (VAB) to reliably diagnose a pathologic complete response in the breast (pCR-B). SUMMARY BACKGROUND DATA Neoadjuvant systemic treatment (NST) elicits a pathologic complete response in up to 80% of women with breast cancer. In such cases, breast surgery, the gold standard for confirming pCR-B, may be considered overtreatment. METHODS This multicenter, prospective trial enrolled 452 women presenting with initial stage 1-3 breast cancer of all biological subtypes. Fifty-four women dropped out; 398 were included in the full analysis. All participants had an imaging-confirmed partial or complete response to NST and underwent study-specific image-guided VAB before guideline-adherent breast surgery. The primary endpoint was the false-negative rate (FNR) of VAB-confirmed pCR-B. RESULTS Image-guided VAB alone did not detect surgically confirmed residual tumor in 37 of 208 women [FNR, 17.8%; 95% confidence interval (CI), 12.8-23.7%]. Of these 37 women, 12 (32.4%) had residual DCIS only, 20 (54.1%) had minimal residual tumor (<5 mm), and 19 of 25 (76.0%) exhibited invasive cancer cellularity of ≤10%. In 19 of the 37 cases (51.4%), the false-negative result was potentially avoidable. Exploratory analysis showed that performing VAB with the largest needle by volume (7-gauge) resulted in no false-negative results and that combining imaging and image-guided VAB into a single diagnostic test lowered the FNR to 6.2% (95% CI, 3.4%-10.5%). CONCLUSIONS Image-guided VAB missed residual disease more often than expected. Refinements in procedure and patient selection seem possible and necessary before omitting breast surgery.
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Affiliation(s)
- Joerg Heil
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
| | - André Pfob
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Department of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Paul Bach
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Bettina Thomas
- Coordination Centre for Clinical Trials (KKS), University Heidelberg, Heidelberg, Germany
| | - Benedikt Schaefgen
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Toralf Reimer
- Department of Gynecology/Breast Unit, University Hospital Rostock, Rostock, Germany
| | - Markus Hahn
- Department of Gynecology/Breast Unit, University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Department of Gynecology and Gynecological Oncology/Breast Unit, Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology/Breast Unit, University Hospital Berlin, Berlin, Germany
| | - John Hackmann
- Department of Gynecology/Breast Unit, Marienhospital, Witten, Germany
| | - Wolfram Malter
- Department of Gynecology/Breast Unit, University Hospital of Cologne, Köln, Germany
| | - Inga Bekes
- Department of Gynecology/Breast Unit, University Hospital Ulm, Ulm, Germany
| | - Kay Friedrichs
- Department of Gynecology/Breast Unit, Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Sebastian Wojcinski
- Department of Gynecology/Breast Unit, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | - Sylvie Joos
- Department of Radiology, Visiorad, Pinneberg, Germany
| | - Stefan Paepke
- Department of Gynecology/Breast Unit, Hospital rechts der Isar, Munich, Germany
| | - Nina Ditsch
- Department of Gynecology/Breast Unit, University Hospital Munich, Munich, Germany
- Department of Gynecology/Breast Unit, University Hospital Augsburg, Augsburg, Germany
| | - Achim Rody
- Department of Gynecology/Breast Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Regina Große
- Department of Gynecology/Breast Unit, University Hospital Halle, Halle, Germany
| | | | | | - Maria Karsten
- Department of Gynecology/Breast Unit, University Hospital Berlin, Berlin, Germany
| | - Michael Golatta
- Department of Gynecology/Breast Unit, University Hospital Heidelberg, Heidelberg, Germany
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Pfob A, Sidey-Gibbons C, Rauch G, Thomas B, Schaefgen B, Kuemmel S, Reimer T, Hahn M, Thill M, Blohmer JU, Hackmann J, Malter W, Bekes I, Friedrichs K, Wojcinski S, Joos S, Paepke S, Degenhardt T, Rom J, Rody A, Große R, van Mackelenbergh M, Reinisch M, Karsten M, Golatta M, Heil J. Abstract PD7-02: Intelligent vacuum-assisted breast biopsy to identify breast cancer patients with pathologic complete response after neoadjuvant systemic treatment for omission of breast and axillary surgery. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd7-02] [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: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant systemic treatment (NST) elicits a pathologic complete response (pCR, ypT0, ypN0) in 40-70% of women with HER2 positive, triple-negative, and high-proliferative Luminal B breast cancer. These patients may not need surgery as all local tumor has already been eradicated by NST. However, their safe identification prior to surgery is a major challenge: imaging after NST, minimally-invasive biopsies, or combinations of both using narrow patient selection criteria are not accurate enough either because they showed high rates of missed cancer or high rates of missed pCR. Recently, the concept of an intelligent, minimally-invasive, vacuum-assisted biopsy (intelligent VAB) was introduced to identify exceptional responders to NST. The intelligent VAB is a multivariate risk algorithm that uses artificial intelligence techniques to analyze conventional VAB results alongside contextualizing patient, imaging, and tumor information. It showed great potential to reliably identify patients with a pCR in the breast (ypT0). However, the absent integration of the axillary status impairs clinical applicability. In this study, we evaluated the feasibility of an intelligent VAB to identify exceptional responders to NST in the breast and axilla. Methods: We trained, tested, and validated a machine learning algorithm (Extreme Gradient Boosting Tree) using patient, imaging, tumor, and conventional VAB variables to detect residual cancer after NST (ypT+/is or ypN+) prior to surgery. We used data from 318 women with cT1-3, cN0/+, HER2 positive, triple-negative breast or high-proliferative Luminal B breast cancer who underwent VAB before surgery (NCT02948764). We used 10-fold cross-validation to train and test the algorithm which was externally validated using data of an independent, similar trial (NCT02575612). Findings were compared to the histopathologic evaluation of the surgical specimen. False-negative rate (FNR), specificity, and area under the ROC curve (AUROC) were the main outcome measures. Results: In the development set (n=318), mean patient age was 52.5 years and 45.3% (144 of 318) achieved a pCR (ypT0 and ypN0). Using resampling methods, the intelligent VAB showed an FNR of 5.2% (9 of 174, 95% CI 2.4-9.5), a specificity of 37.5% (54 of 144, 95% CI 29.6-45.9), and an AUROC of 0.92 (95% CI 0.90-0.94) in the development set to detect residual cancer (ypT+/is or ypN+) after NST. In the external validation set (n=45), mean patient age was 48.1 years and 44.4% (20 of 45) achieved a pCR. The intelligent VAB showed an FNR of 0% (0 of 25, 95% CI 0.0-13.7), a specificity of 40.0% (8 of 20, 95% CI 19.1-63.9) and an AUROC of 0.91 (95% CI 0.82-0.97). Spiegelhalter’s Z confirmed a well-calibrated model (z score -0.746, P 0.228). FNR of the intelligent VAB was lower compared to imaging after NST, conventional VAB, or combinations of both using narrow patient selection criteria. Conclusion: An intelligent VAB can reliably exclude residual cancer after NST for women with cT1-3, cN0/+, HER2 positive, triple-negative breast or high-proliferative Luminal B breast cancer. The omission of breast and axillary surgery for these exceptional responders may be evaluated in future trials. Trial registration: NCT02948764 and NCT02575612. Funding: German Research Foundation (DFG)
Diagnostic Performance ComparisonFalse-negative rate - % (95% CI); no.Specificity - % (95% CI); no.Negative predictive value - % (95% CI); no.Positive predictive value - % (95% CI); no.AUROC - value (95% CI)Development set (n=318)Imaging after NST24.4% (18.0-13.7); 40 of 16452.2% (43.4-61.0); 69 of 13263.3% (53.5-72.3); 69 of 10966.3% (59.1-73.0); 124 of 187-Conventional VAB32.8% (25.8-40.3); 57 of 174100% (97.5-100); 144 of 14471.6% (64.9-77.8); 144 of 201100% (96.9-100); 117 of 117-Imaging after NST + VAB16.7% (11.4-23.2); 28 of 16832.1% (24.4-40.6); 44 of 13761.1% (48.9-72.4); 44 of 7260.1% (56.1-69.1); 140 of 223-VAB + patient selection9.1% (5.0-14.1) 15 of 17036.3% (28.2-45.0); 49 of 13576.6% (64.3-86.2); 49 of 6464.3% (57.9-70.4); 155 of 241-Intelligent VAB (Extreme Gradient Boosting tree)5.2% (2.4-9.6); 9 of 17437.5% (29.6-45.9); 54 of 14485.7% (74.6-93.3); 54 of 6364.7% (58.5-70.6); 165 of 2550.92 (0.90-0.94)External validation (n=45)Imaging after NST24.0% (9.4-45.1%);6 of 2565.0% (40.8-84.6%);13 of 2068.4% (43.4-87.4%);13 of 1973.1% (52.2-88.4%);19 of 26-Conventional VAB28.0% (12.1-49.4%);7 of 25100% (83.2-100%);20 of 2074.1% (53.7-88.9%);20 of 27100% (81.5-100%);18 of 18-Imaging after NST + VAB12.0% (2.5-31.2); 3 of 2565.0% (40.8-84.6%);13 of 2081.3% (54.4-96.0%); 13 of 1675.9% (56.5-89.7%); 22 of 29-VAB + patient selection4.0% (1.0-2.4); 1 of 2530.0% (9.4-45.1%); 6 of 2085.7% (69.8-99.8); 6 of 763.2% (46.0-78.2); 24 of 38-Intelligent VAB (Extreme Gradient Boosting tree)0.0% (0.0-13.7%);0 of 2540.0% (19.1-63.9%);8 of 20100% (63.1-100%);8 of 867.8% (50.2-82.0%);25 of 370.91 (0.82 - 0.97)AUROC = Area under the receiver operating characteristic curve; CI = confidence interval
Citation Format: André Pfob, Chris Sidey-Gibbons, Geraldine Rauch, Bettina Thomas, Benedikt Schaefgen, Sherko Kuemmel, Toralf Reimer, Markus Hahn, Marc Thill, Jens-Uwe Blohmer, John Hackmann, Wolfram Malter, Inga Bekes, Kay Friedrichs, Sebastian Wojcinski, Sylvie Joos, Stefan Paepke, Tom Degenhardt, Joachim Rom, Achim Rody, Regina Große, Marion van Mackelenbergh, Mattea Reinisch, Maria Karsten, Michael Golatta, Joerg Heil. Intelligent vacuum-assisted breast biopsy to identify breast cancer patients with pathologic complete response after neoadjuvant systemic treatment for omission of breast and axillary surgery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD7-02.
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Affiliation(s)
- André Pfob
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | | | | | - Markus Hahn
- University Hospital Tuebingen, Tuebingen, Germany
| | - Marc Thill
- Agaplesion Markus Hospital Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | | | | | | | - Joachim Rom
- Klinikum Frankfurt-Höchst, Frankfurt, Germany
| | - Achim Rody
- University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | | | | | | | | | - Joerg Heil
- Heidelberg University Hospital, Heidelberg, Germany
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Graf J, Sickenberger N, Brusniak K, Matthies LM, Deutsch TM, Simoes E, Plappert C, Keilmann L, Hartkopf A, Walter CB, Hahn M, Engler T, Wallwiener S, Schuetz F, Fasching PA, Schneeweiss A, Brucker SY, Wallwiener M. Implementation of an Electronic Patient-Reported Outcome App for Health-Related Quality of Life in Breast Cancer Patients: Evaluation and Acceptability Analysis in a Two-Center Prospective Trial. J Med Internet Res 2022; 24:e16128. [PMID: 35133288 PMCID: PMC8864528 DOI: 10.2196/16128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/24/2021] [Accepted: 09/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid. Objective The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors. Methods Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere. Results Patients regarded the ePRO assessment as more suitable (80/106, 75.5%), less stressful (73/106, 68.9%), and less difficult (69/106, 65.1%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app’s evaluation parameters. Conclusions The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills.
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Affiliation(s)
- Joachim Graf
- Institute for Health Sciences, Section of Midwifery Science, University Hospital Tübingen, Tübingen, Germany
| | - Nina Sickenberger
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Brusniak
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lina Maria Matthies
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Thomas M Deutsch
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Elisabeth Simoes
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Claudia Plappert
- Institute for Health Sciences, Section of Midwifery Science, University Hospital Tübingen, Tübingen, Germany
| | - Lucia Keilmann
- Department of Obstetrics and Gynecology, University Hospital Ludwig-Maximilians-University Munich, München, Germany
| | - Andreas Hartkopf
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | | | - Markus Hahn
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Engler
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Stephanie Wallwiener
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Schuetz
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany.,Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany.,University Breast Center Franconia, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Sara Yvonne Brucker
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany.,Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Markus Wallwiener
- Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
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Volmer L, Koch A, Matovina S, Dannehl D, Weiss M, Welker G, Hahn M, Engler T, Wallwiener M, Walter CB, Oberlechner E, Brucker SY, Pantel K, Hartkopf A. Neoadjuvant Chemotherapy of Patients with Early Breast Cancer Is Associated with Increased Detection of Disseminated Tumor Cells in the Bone Marrow. Cancers (Basel) 2022; 14:cancers14030635. [PMID: 35158902 PMCID: PMC8833450 DOI: 10.3390/cancers14030635] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Disseminated tumor cells (DTCs) present in the bone marrow of breast cancer patients are an indicator of minimal residual disease and micrometastatic spread. These cells can already be found at the earliest disease stages and are associated with poorer outcomes. In preclinical models, neoadjuvant chemotherapy was shown to promote micrometastatic spread. The aim of this large single-center retrospective study was to compare the frequency and prognostic significance of DTC detection between patients treated with neoadjuvant chemotherapy and treatment-naive patients. Abstract Preclinical data suggest that neoadjuvant chemotherapy (NAT) may promote micrometastatic spread. We aimed to compare the detection rate and prognostic relevance of disseminated tumor cells (DTCs) from the bone marrow (BM) of patients with early-stage breast cancer (EBC) after NAT with that of therapy-naive EBC patients. DTCs were identified from BM samples, collected during primary surgery. Patients who received NAT were compared to patients who received chemotherapy after surgery. In total, 809 patients were analyzed. After NAT, 45.4% of patients were DTC-positive as compared to 19.9% of patients in the adjuvant chemotherapy group (p < 0.001). When sampled in patients who had undergone NAT, the detection of DTCs in the BM was significantly increased (OR: 3.1; 95% confidence interval (CI): 2.1–4.4; p < 0.001). After NAT, DTC-positive patients with ≥2 DTCs per 1.5 × 106 mononuclear cells in their BM had an impaired disease-free survival (HR: 4.8, 95% CI: 0.9–26.6; p = 0.050) and overall survival (HR: 4.2; 95% CI: 1.4–12.7; p = 0.005). The higher rate of DTC-positive patients after NAT as compared to a treatment-naive comparable control cohort suggests that NAT supports tumor cell dissemination into the bone marrow. DTC positivity in BM predicted relapse in various distant organs, implying that tumor cell dissemination was not restricted to the bone marrow.
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Affiliation(s)
- Léa Volmer
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
- Correspondence: ; Tel./Fax: +49-7071-29-82211
| | - André Koch
- Research Institute for Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (A.K.); (G.W.)
| | - Sabine Matovina
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Dominik Dannehl
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Martin Weiss
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Ganna Welker
- Research Institute for Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (A.K.); (G.W.)
| | - Markus Hahn
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Tobias Engler
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University Medical Center Heidelberg, 69120 Heidelberg, Germany;
| | - Christina Barbara Walter
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Ernst Oberlechner
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Sara Yvonne Brucker
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Andreas Hartkopf
- Department of Women’s Health, University Medical Center Tübingen, 72076 Tübingen, Germany; (S.M.); (D.D.); (M.W.); (M.H.); (T.E.); (C.B.W.); (E.O.); (S.Y.B.); (A.H.)
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Gerber B, Schneeweiss A, Möbus V, Golatta M, Tesch H, Krug D, Hanusch C, Denkert C, Lübbe K, Heil J, Huober J, Ataseven B, Klare P, Hahn M, Untch M, Kast K, Jackisch C, Thomalla J, Seither F, Blohmer JU, Rhiem K, Fasching PA, Nekljudova V, Loibl S, Kühn T. Pathological Response in the Breast and Axillary Lymph Nodes after Neoadjuvant Systemic Treatment in Patients with Initially Node-Positive Breast Cancer Correlates with Disease Free Survival: An Exploratory Analysis of the GeparOcto Trial. Cancers (Basel) 2022; 14:cancers14030521. [PMID: 35158789 PMCID: PMC8833390 DOI: 10.3390/cancers14030521] [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: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The extent of axillary surgery has been reduced in recent years to minimize side effects. However, a negative impact of reduced surgery on outcome must be avoided. We investigated for whom the extent of surgery can be safely reduced by examining early-stage breast cancer patients converting from lymph node (LN)-positive to LN-negative disease after neoadjuvant systemic treatment (NAST). Of 242 initially LN-positive patients treated within the GeparOcto trial, 54.5% were classified as LN-negative after NAST, 31.8% as LN-positive, and for 13.6% data were missing. Overall, 92.1% of patients underwent complete axillary LN dissection, with 6.6% undergoing sentinel LN dissection only. At surgery, 55.4% of patients had no signs of cancer in the LN, 45.0% had no signs of cancer in the breast (of those 8.3% had involved LN), and 41.3% had no signs of cancer at all. Patients with involved LN still had a bad prognosis. Conversion from LN-positive to LN-negative after NAST is of highest prognostic value. Surgical axillary staging after NAST is essential in these patients to offer tailored treatment. Abstract Background: The conversion of initially histologically confirmed axillary lymph node-positive (pN+) to ypN0 after neoadjuvant systemic treatment (NAST) is an important prognostic factor in breast cancer (BC) patients and may influence surgical de-escalation strategies. We aimed to determine pCR rates in lymph nodes (pCR-LN), the breast (pCR-B), and both (tpCR) in women who present with pN+ BC, to assess predictors for response and the impact of pCR-LN, pCR-B, and tpCR on invasive disease-free survival (iDFS). Methods: Retrospective, exploratory analysis of 242 patients with pN+ at diagnosis from the multicentric, randomized GeparOcto trial. Results: Of 242 patients with initially pN+ disease, 134 (55.4%) had a pCR-LN, and 109 (45.0%) a pCR-B. Of the 109 pCR-B patients, 9 (8.3%) patients had involved LN, and 100 (41.3%) patients had tpCR. Those with involved LN still had a bad prognosis. As expected, pCR-B and intrinsic subtypes (TNBC and HER2+) were identified as independent predictors of pCR-LN. pCR-LN (ypN0; hazard ratio 0.42; 95%, CI 0.23–0.75; p = 0.0028 for iDFS) was the strongest independent prognostic factor. Conclusions: In initially pN+ patients undergoing NAST, the conversion to ypN0 is of high prognostic value. Surgical axillary staging after NAST is still essential in these patients to offer tailored treatment.
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Affiliation(s)
- Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany;
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany;
| | - Volker Möbus
- Medical Clinic II, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany;
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany; (M.G.); (J.H.)
| | - Hans Tesch
- Oncology Practice, Bethanien Hospital Frankfurt, Im Prüfling 17-19, 60389 Frankfurt, Germany;
| | - David Krug
- Department of Radiotherapy, University Hospital Schleswig Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany;
| | - Claus Hanusch
- Department of Senology, Rotkreuz-Klinikum, Rotkreuzplatz 8, 80634 Munich, Germany;
| | - Carsten Denkert
- Institute of Pathology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany;
| | - Kristina Lübbe
- Breast Center, Diakovere Henriettenstift, Schwemannstraße 17, 30559 Hannover, Germany;
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany; (M.G.); (J.H.)
| | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany;
| | - Beyhan Ataseven
- Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany;
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Henricistraße 92, 45136 Essen, Germany
| | - Peter Klare
- Oncologic Medical Care Center Krebsheilkunde, Möllendorffstraße 52, 10367 Berlin, Germany;
| | - Markus Hahn
- Department for Women’s Health, University of Tübingen, Calwerstraße 7, 72076 Tuebingen, Germany;
| | - Michael Untch
- Department of Obstetrics and Gynecology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany;
| | - Karin Kast
- Center for Hereditary Breast and Ovarian Cancer, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany;
| | - Christian Jackisch
- Department of Obstetrics and Gynecology, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069 Offenbach, Germany;
| | - Jörg Thomalla
- Praxisklinik für Hämatologie und Onkologie Koblenz, Neversstraße 5, 56068 Koblenz, Germany;
| | - Fenja Seither
- German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany; (F.S.); (V.N.)
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center Charité, Charitéplatz 1, 10117 Berlin, Germany;
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany;
| | - Peter A. Fasching
- Department of Obstetrics and Gynecology, University of Erlangen, Universitätsstraße 21/23, 91054 Erlangen, Germany;
| | - Valentina Nekljudova
- German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany; (F.S.); (V.N.)
| | - Sibylle Loibl
- German Breast Group, Martin Behaim Strasse 12, 63263 Neu-Isenburg, Germany; (F.S.); (V.N.)
- Correspondence: ; Tel.: +49-610-2748-0411; Fax: +49-610-2748-0111
| | - Thorsten Kühn
- Department of Gynecology, Klinikum Esslingen, Hirschlandstraße 97, 73730 Esslingen, Germany;
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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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Golatta M, Pfob A, Büsch C, Bruckner T, Alwafai Z, Balleyguier C, Clevert DA, Duda V, Goncalo M, Gruber I, Hahn M, Kapetas P, Ohlinger R, Rutten M, Togawa R, Tozaki M, Wojcinski S, Rauch G, Heil J, Barr RG. The potential of combined shear wave and strain elastography to reduce unnecessary biopsies in breast cancer diagnostics - An international, multicentre trial. Eur J Cancer 2021; 161:1-9. [PMID: 34879299 DOI: 10.1016/j.ejca.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/20/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Shear wave elastography (SWE) and strain elastography (SE) have shown promising potential in breast cancer diagnostics by evaluating the stiffness of a lesion. Combining these two techniques could further improve the diagnostic performance. We aimed to exploratorily define the cut-offs at which adding combined SWE and SE to B-mode breast ultrasound could help reclassify Breast Imaging Reporting and Data System (BI-RADS) 3-4 lesions to reduce the number of unnecessary breast biopsies. METHODS We report the secondary results of a prospective, multicentre, international trial (NCT02638935). The trial enrolled 1288 women with BI-RADS 3 to 4c breast masses on conventional B-mode breast ultrasound. All patients underwent SWE and SE (index test) and histopathologic evaluation (reference standard). Reduction of unnecessary biopsies (biopsies in benign lesions) and missed malignancies after recategorising with SWE and SE were the outcome measures. RESULTS On performing histopathologic evaluation, 368 of 1288 breast masses were malignant. Following the routine B-mode breast ultrasound assessment, 53.80% (495 of 920 patients) underwent an unnecessary biopsy. After recategorising BI-RADS 4a lesions (SWE cut-off ≥3.70 m/s, SE cut-off ≥1.0), 34.78% (320 of 920 patients) underwent an unnecessary biopsy corresponding to a 35.35% (320 versus 495) reduction of unnecessary biopsies. Malignancies in the new BI-RADS 3 cohort were missed in 1.96% (12 of 612 patients). CONCLUSION Adding combined SWE and SE to routine B-mode breast ultrasound to recategorise BI-RADS 4a patients could help reduce the number of unnecessary biopsies in breast diagnostics by about 35% while keeping the rate of undetected malignancies below the 2% ACR BI-RADS 3 definition.
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Affiliation(s)
- Michael Golatta
- University Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.
| | - André Pfob
- University Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany. https://twitter.com/andrepfob
| | - Christopher Büsch
- Institute of Medical Biometry (IMBI), Heidelberg University, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry (IMBI), Heidelberg University, 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
| | - Manuela Goncalo
- Department of Radiology, University Hospital 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
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ralf Ohlinger
- Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
| | - Matthieu Rutten
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands; Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Riku Togawa
- University Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sebastian Wojcinski
- Department of Gynecology and Obstetrics, Breast Cancer Center, Klinikum Bielefeld Mitte GmbH, Bielefeld, Germany
| | - Geraldine Rauch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joerg Heil
- University Breast Unit, Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard G Barr
- Department of Radiology, Northeast Ohio Medical University, Ravenna, USA
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Simoes E, Sokolov AN, Hahn M, Fallgatter AJ, Brucker SY, Wallwiener D, Pavlova MA. How Negative Is Negative Information. Front Neurosci 2021; 15:742576. [PMID: 34557072 PMCID: PMC8452949 DOI: 10.3389/fnins.2021.742576] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022] Open
Abstract
Daily, we face a plenty of negative information that can profoundly affect our perception and behavior. During devastating events such as the current COVID-19 pandemic, negative messages may hinder reasoning at individual level and social decisions in the society at large. These effects vary across genders in neurotypical populations (being more evident in women) and may be even more pronounced in individuals with neuropsychiatric disorders such as depression. Here, we examine how negative information impacts reasoning on a social perception task in females with breast cancer, a life-threatening disease. Two groups of patients and two groups of matched controls (NTOTAL = 80; median age, 50 years) accomplished a psychometrically standardized social cognition and reasoning task receiving either the standard instruction solely or additional negative information. Performance substantially dropped in patients and matched controls who received negative information compared to those who did not. Moreover, patients with negative information scored much lower not only compared with controls but also with patients without negative information. We suggest the effects of negative information are mediated by the distributed brain networks involved in affective processing and emotional memory. The findings offer novel insights on the impact of negative information on social perception and decision making during life-threatening events, fostering better understanding of its neurobiological underpinnings.
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Affiliation(s)
- Elisabeth Simoes
- Department of Women's Health, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany.,Executive Department for Social Medicine, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Alexander N Sokolov
- Department of Women's Health, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen and Tübingen Center for Mental Health (TüCMH), Tübingen, Germany
| | - Markus Hahn
- Department of Women's Health, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen and Tübingen Center for Mental Health (TüCMH), Tübingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Diethelm Wallwiener
- Department of Women's Health, University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marina A Pavlova
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen and Tübingen Center for Mental Health (TüCMH), Tübingen, Germany
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44
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Guergan S, Hoopmann U, Roehm C, Boeer B, Fugunt R, Helms G, Seller A, Marx M, Oberlechner E, Hartkopf A, Preibsch H, Brucker S, Wallwiener D, Hahn M, Gruber IV. Evaluation of sonographic detectability of different markers within an in vitro simulation model of the axilla. Arch Gynecol Obstet 2021; 304:839-848. [PMID: 34142225 PMCID: PMC8325667 DOI: 10.1007/s00404-021-06085-9] [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: 01/25/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Clip-marking of axillary lymph nodes with initial biopsy-confirmed metastasis is required for targeted axillary dissection (TAD), which includes sentinel lymph node dissection (SLND) and selective localization and removal of the clipped targeted lymph node. There have been several studies which examined the feasibility of TAD in routine clinical use. In this context, the optimal clip visualisation was noted as one of the crucial limiting factors. We, therefore, evaluated the sonographic detectability of 10 different commercially available markers within an in vitro model simulating the anatomical composition of the axilla. METHODS In this standardised model consisting of porcine fat with 30 mm thickness, the visibility of a total of ten markers was analysed in all 3 planes (parallel, diagonal, orthograde) with wire guidance and then classified into either "visibility good", "visibility moderate" or "visibility poor" with regard to the alignment of the transducer. Additionally, "real-life conditions" were simulated, in which the markers were searched without any wires guidance. RESULTS It was observed that, while not all markers are detectable in fatty tissue, markers with spherical shape (non-embedded Inconel or Nitinol) or rectangular-shaped Titanium markers with embedded material have a clear advantage. 3D-shaped markers can always be detected in all three axes, which is of particular importance in the axilla with its pyramid shape and fatty tissue. CONCLUSION The shape and the embedding of the material play a crucial role for visibility and efficacy of the marker, as reliable marking of suspicious and pathological axillary lymph nodes is essential for TAD.
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Affiliation(s)
- Selin Guergan
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Uta Hoopmann
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Carmen Roehm
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Bettina Boeer
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Regina Fugunt
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Gisela Helms
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Anna Seller
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Mario Marx
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.,Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany
| | - Ernst Oberlechner
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Andreas Hartkopf
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Heike Preibsch
- Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Sara Brucker
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Diethelm Wallwiener
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Markus Hahn
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Ines Verena Gruber
- Department for Women's Health, University of Tübingen, Calwerstraße 7, 72076, Tübingen, Germany.
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Caro C, Freude W, Florek A, Morgenstern S, Boeer B, Roehm C, Hahn M, Marx M. Simultaneous correction of a pectus excavatum with tubular breast deformity using a custom-made silicone implant. Arch Gynecol Obstet 2021; 303:1025-1037. [PMID: 33389096 DOI: 10.1007/s00404-020-05898-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
Pectus excavatum (PE) is one of the most common congenital deformities of the thorax and is characterized by a depressed sternum with reduction of the antero-posterior thoracic diameter. Although the majority of patients with PE have no physiologic limitations, it is often associated with psychological problems influencing the patients' quality of life. Surgical treatment options show particular variation with regard to invasiveness and morbidity of the respective procedures. Surgical treatment using a custom-made silicone implant represents a less invasive alternative for patients without further accompanying physical symptoms. This article describes the simultaneous correction of a PE combined with tubular breast deformity using this minimally invasive technique.
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Affiliation(s)
- C Caro
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - W Freude
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - A Florek
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - S Morgenstern
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - B Boeer
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - C Roehm
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - M Hahn
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - M Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany.
- Department of Women's Health, University of Tübingen, Tübingen, Germany.
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Paepke S, Thill M, Peisker U, Ohlinger R, Gruber I, Malter W, Kümmel S, Hahn M, Kühn T, Reinisch M, Stachs A, Reimer T. One size fits all? Novel pulse biopsy platform offers improved needle control, high tissue yield and multiple needle options – pre-clinical results. Breast 2021. [DOI: 10.1016/s0960-9776(21)00172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kolberg HC, Röhm C, Stachs A, Schütz F, Blohmer JU, Wetzig S, Hartmann S, Heil J, Hahn M. Abstract PS1-21: Molecular fluorescence-guided surgery using Beva800 for the assessment of tumor margins during breast conserving surgery of patients with primary breast cancer (MARGIN-II). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps1-21] [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: 11/16/2022]
Abstract
Abstract
Introduction:The goal of breast conserving surgery (BCS) for early breast cancer (EBC) is to remove the tumor and a surrounding rim of normal tissue, while preserving as much of the normal breast tissue as possible. Incomplete resections are associated with higher rates of surgical re-excision. Repeat surgeries are not only a burden to patients physically but also psychologically and can delay recommended adjuvant therapies. Accurate determination of tumor margins during surgery is therefore critical for successful outcome. Breast cancer tissue produces significantly higher amounts of VEGF-A than healthy tissue. VEGF-A stimulates tumor angiogenesis and is therefore an excellent target for molecular imaging techniques. The fluorescence imaging agent bevacizumab-IRDye800CW (Beva800) is a conjugate of bevacizumab (a humanized antibody targeting human VEGF) and IRDye800CW (a near-infrared fluorescence dye) which binds specifically to VEGF-A. Beva800 provides a potentially highly efficacious approach to imaging specimen and cavity margins during BCS. Herein we present a phase II study that combined Beva800 with the SurgVision Explorer Air camera for intraoperative margin assessment during BCS for EBC.Methods:MARGIN II is a multicenter open-label single arm prospective clinical trial aimed at evaluating Beva800 for assessment of tumor margins in women with EBC scheduled for BCS. The study was a within-patient comparison of positive tumor margin rates using BCS standard of care compared to intraoperative assessment with 4.5 mg Beva800 and fluorescence imaging with the SurgVision Explorer Air camera. Patients undergoing neoadjuvant chemotherapy were excluded. All patients received a single intra-venous bolus injection of 4.5 mg of Beva800 three days before surgery. The fluorescent signal was visualized during surgery using NIR fluorescence imaging (700-1000 nm). This wavelength window typically has very low tissue auto-fluorescence (filtering out background noise) and greater tissue penetration depth due to reduced haemoglobin absorption. Standard of care assessment was defined as visual inspection, palpation and, in cases of pre-operative wire marking, specimen sonography or mammography. Beva800 efficacy was determined as the number of patients in which a pathology-confirmed positive margin was identified by fluorescence guided surgery using Beva800 but not by standard of care BCS. The results per patient were divided into two clusters: results after standard of care BCS and results after fluorescence guided surgery, according to their margin status at pathology. The need for re-operation because of involved margins within 30 days after the first BCS and the safety of 4.5 mg Beva800 was assessed.Results:The recruitment goal of 40 patients in 5 centers has almost been reached and results of the final analysis will be presented at the meeting.Conclusion:Molecular fluorescence-guided surgery using Beva800 has the potential to change the practice of breast conserving surgery by avoiding unnecessary re-operations. This would lead to fewer interventions, a reduced burden on patients through repeat surgery and reduced delay of adjuvant therapies.
Citation Format: Hans-Christian Kolberg, Carmen Röhm, Angrit Stachs, Florian Schütz, Jens-Uwe Blohmer, Sarah Wetzig, Steffi Hartmann, Jörg Heil, Markus Hahn. Molecular fluorescence-guided surgery using Beva800 for the assessment of tumor margins during breast conserving surgery of patients with primary breast cancer (MARGIN-II) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-21.
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Affiliation(s)
| | - Carmen Röhm
- 2Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Florian Schütz
- 4Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | | | | | | | - Jörg Heil
- 6Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Markus Hahn
- 2Universitätsklinikum Tübingen, Tübingen, Germany
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Andes FT, Adam S, Hahn M, Aust O, Frey S, Grueneboom A, Nitschke L, Schett G, Steffen U. The human sialic acid-binding immunoglobulin-like lectin Siglec-9 and its murine homolog Siglec-E control osteoclast activity and bone resorption. Bone 2021; 143:115665. [PMID: 33007530 DOI: 10.1016/j.bone.2020.115665] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 02/08/2023]
Abstract
Regulation of osteoclast differentiation and function is a central element in bone homeostasis. While the role of soluble factors, such as cytokines, hormones and growth factors, in controlling osteoclast differentiation has been intensively characterized, the function of surface receptors is less well understood. Sialic acid-binding immunoglobulin-like lectin (Siglec)-9 and its murine homolog Siglec-E are sialic acid-recognizing inhibitory receptors from the CD33-related Siglec-family and mainly expressed on myeloid cells. We found Siglec-9 and Siglec-E to be expressed at all stages of human and murine osteoclastogenesis, respectively. Siglec-E knockout mice displayed lower bone mass despite unchanged osteoclast numbers and an increased bone formation rate. Ex vivo osteoclast assays using Siglec-E knockout cells or a blocking antibody against human Siglec-9 confirmed the suppressive effect of Siglec-9/Siglec-E on osteoclast function. Although osteoclast numbers were unchanged or even slightly decreased, the blockade/absence of Siglec-9/Siglec-E resulted in an augmented resorption activity of mature osteoclasts. This increased resorption activity was associated with enlarged actin rings. Together, our results suggest Siglec-9/Siglec-E to inhibit osteoclast activation independently from osteoclast differentiation and thereby propose a new mechanism for the control of local bone resorption.
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Affiliation(s)
- F T Andes
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - S Adam
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - M Hahn
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - O Aust
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - S Frey
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - A Grueneboom
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - L Nitschke
- Department of Genetics, Friedrich-Alexander University Erlangen-Nürnberg, Germany
| | - G Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - U Steffen
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany.
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Hahn M, Preibsch H. [Interventional techniques for the breast]. Radiologe 2021; 61:159-165. [PMID: 33427890 DOI: 10.1007/s00117-020-00800-4] [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] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventional methods of the breast serve as percutaneous minimally invasive diagnostic tools in case of suspicious findings in the breast or axilla. Further indications are lesion localization and the minimally invasive therapeutic approach. OBJECTIVES Aim of this paper is to give an overview of the existing methods, their indications and the imaging techniques for guidance. On the basis of the most recent publications, clinical management is described.
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Affiliation(s)
- M Hahn
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland.
| | - H Preibsch
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
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50
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Boeer B, Schneider J, Schoenfisch B, Röhm C, Paepke S, Oberlechner E, Ohlinger R, Hartkopf A, Brucker SY, Hahn M, Marx M. Lysine-urethane-based tissue adhesion for mastectomy-an approach to reducing the seroma rate? Arch Gynecol Obstet 2020; 303:181-188. [PMID: 33146769 PMCID: PMC7854407 DOI: 10.1007/s00404-020-05801-1] [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: 06/30/2020] [Accepted: 09/16/2020] [Indexed: 11/05/2022]
Abstract
Purpose Postoperative seromas are a problem in the surgical treatment of breast cancer. The aim of the study was to evaluate whether the lysine-urethane-based tissue adhesive TissuGlu® without drainage is equal/ non-inferior to standard mastecomy with drainage. Methods The study was designed as a prospective, randomized, multicentre non-inferiority study comparing the use of TissuGlu® without drainage with standard wound care with a drain insertion in ablative breast procedures. The number of clinical interventions, quality of life and wound complications were followed-up for 90 days in both groups. Results Although the statistical power was not reached, twice as many clinical interventions were performed in the TissuGlu® group than in the drainage group, especially aspirations of clinically relevant seromas (p = 0.014). The TissuGlu® group produced overall less wound fluid, but developed a clinically relevant seroma (100% vs. 63%) which made an intervention necessary. Less hospitalisation time was observed in the TissuGlu® group, but the complication rate was higher. There was no significant difference in regards to postoperative pain. In summary the non-inferiority of TissuGlu® compared to standard drainage couldn’t be reached. Discussion The present evaluation shows no advantage of the tissue adhesive TissuGlu® in terms of seroma formation and frequency of intervention compared to a standard drainage for mastectomies, but the shorter inpatient stay certainly has a positive effect on the quality of life.
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Affiliation(s)
- B Boeer
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany.
| | - J Schneider
- Department of Urology, Klinikum Am Steinenberg, Reutlingen, Germany
| | - B Schoenfisch
- Research Institute for Women's Health, University of Tuebingen, Tuebingen, Germany
| | - C Röhm
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany
| | - S Paepke
- Department of Obstetrics and Gynaecology, Technical University of Munich, Munich, Germany
| | - E Oberlechner
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany
| | - R Ohlinger
- Department of Gynaecology and Obstetrics, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - A Hartkopf
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany
| | - S Y Brucker
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany
| | - M Hahn
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tuebingen, Germany
| | - M Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elblandklinikum Radebeul, Radebeul, Germany
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