Management and Outcomes in Patients with Breast Cancer with 1-of-1 and 2-of-2 Positive Sentinel Nodes.

Background: The ACOSOG-Z0011 and AMAROS trials showed that axillary lymph node dissection (ALND) provided no benefit for patients with 1-2 positive sentinel lymph nodes (+SLNs). There remains apprehension to omit ALND for patients in whom only 1-2 SLNs are retrieved and all are positive. This study evaluates current practices and pathological findings when ALND is pursued.

Breast Cancer Upstaging Risk and In Vivo Tumor Growth Rates Associated with Preoperative Delays.

Background: Preoperative delay when treating breast cancer confers poorer outcomes, but growth rates and the upstaging likelihoods per delay interval remain unknown. This study evaluated upstaging risk, nodal spread, and tumor growth rates in vivo while awaiting treatment.

Patients And Methods: Registry-based data from the national cancer database was reviewed for patients treated between 2010 and 2020 at commission on cancer-accredited facilities, with nonmetastatic, noninflammatory breast cancer, undergoing surgery first.

A Technical Report for Definitive Treatment of Uveal Melanoma With Stereotactic Radiosurgery and Retrobulbar Anesthesia.

Uveal melanoma (UM) is the most common primary intraocular malignancy, traditionally managed with episcleral plaque brachytherapy or enucleation. Single-fraction stereotactic radiosurgery (SRS) using a linear accelerator (LINAC) is an emerging alternative offering high precision and eye preservation. However, existing SRS/stereotactic radiation therapy (SRT) techniques often rely on mechanical immobilization or patient-maintained fixation.

Bridging the Gap: Enhancing First-Year Education Through the Surgical Ethics and Application for Medical Students Program.

Ethical decision-making is fundamental to surgical education, yet formal ethics training remains underrepresented in medical curricula. To address this gap, we developed the Baylor College of Medicine (BCM) Surgical Ethics and Application for Medical Students (SEAMS) program, an elective hybrid course combining 45-minute didactic lectures with interactive role-playing led by faculty experts in ethics, transplant medicine, and surgical oncology. Thirty-two first-year medical students participated in SEAMS and completed pre- and post-program surveys assessing their understanding, confidence, and preferred learning styles related to surgical ethics.

Low Socioeconomic Status at the Patient and Institutional Level Impact Achievement of Breast Cancer Quality Standards.

Background: The National Accreditation Program of Breast Centers (NAPBC) developed comprehensive, multidisciplinary standards to improve quality outcomes. We have previously shown that institutions treating larger proportions of breast cancer patients of low socioeconomic status (SES) achieve these benchmarks at lower rates. This study assesses whether a patient's SES interacts with an institution's SES mix in achieving the 2018 NAPBC standards.

Twenty Years in the Making: An Analysis of National Trends in ACGME Resident Breast Surgery Experiences.

Introduction: Breast surgery is a core component of general surgery; however, previous studies have shown that general surgery residents (GSRs) are performing fewer operations in this area. This study analyzes the 20-y trends in GSR breast surgery experience.

Methods: Case numbers were extracted from the Accreditation Council for Graduate Medical Education database from 2003 to 2023.

Utility of Surgical Axillary Staging in Microinvasive Ductal Carcinoma In Situ: A National Cancer Database Analysis.

Background: Surgical axillary staging (ASx) of patients with microinvasive ductal carcinoma in situ (cT1mi) is debated due to the low occurrence of nodal metastasis. This study aimed to assess the utility of surgical axillary staging for clinically node-negative (cN0) T1mi breast cancer patients.

Methods: This retrospective cohort study analyzed data from the National Cancer Database (NCDB) to investigate the axillary status of patients with cT1mi breast cancer between 2012 and 2019.

Managing Donor Site Pain After Alveolar Bone Grafting: A Comparative Analysis of Liposomal Bupivacaine (Exparel), Bupivacaine-Soaked Gelfoam, and ON-Q Ropivacaine.

Introduction: Traditionally, alveolar bone grafting (ABG) uses bone from the iliac crest for repair. Harvesting this graft has been associated with significant donor site pain. Local anesthetic is a useful adjunct to alleviate postoperative opioid requirements.

Cephalomedullary Nail Fixation for Prophylactic Treatment of Incomplete Femoral Neck Stress Fractures in Athletes.

Background: The traditional management of femoral neck stress fractures (FNSFs)-such as cannulated screw fixation-requires a period of protected weightbearing and does not provide fixed angle stability.

Purpose: To report the technique and outcomes of a single surgeon's case series of prophylactic fixation of incomplete FNSFs using cephalomedullary nailing (CMN) followed by immediate weightbearing.

Study Design: Case series; Level of evidence, 4.

Immunohistochemical Status Predicts Pathologic Complete Response to Neoadjuvant Therapy in HER2-Overexpressing Breast Cancers.

Background: Human epidermal growth factor receptor 2 (HER2) overexpression (HER2+) is defined by immunohistochemistry (IHC) and in situ hybridization (ISH) as IHC3+ or IHC2+/ISH+. Response differences to neoadjuvant anti-HER2 therapy (NT) in IHC3+ versus IHC2+/ISH+ breast cancer patients are poorly characterized. We explored whether pathologic complete response (pCR) varies by HER2 IHC status.

Geospatial Demand for Approved Cleft Care in the United States.

Background: Geographic information systems are powerful tools for characterizing the geospatial factors influencing access to care. As patients with cleft lip and/or palate (CL/P) require long-term care, with numerous operations and therapies, access to timely, quality care is extremely important. This study uses population level analysis and geographic information systems to identify United States counties with limited access to American Cleft Palate Association-approved cleft teams.

Evolving Economics: The Erosion of Medicare Reimbursement in Breast Surgery (2003-2023).

Introduction: Medicare significantly influences reimbursement rates, setting a standard that impacts private insurance policies. Despite declining rates in various specialties, the magnitude of these trends has not been examined in breast surgery. This study examines Medicare reimbursement trends for breast surgery operations.

Should Palpable Nodes Be Exclusionary in Patients Who Are Otherwise Candidates for ACOSOG Z0011-Type Trials?

Background: Palpable nodes were exclusionary in American College of Surgeons Oncology Group (ACOSOG) Z0011, while SINODAR-ONE excluded those with positive axillary nodes by palpation and ultrasound. To determine whether clinical nodal status should be exclusionary in those fulfilling pathologic criteria for ACOSOG Z0011 and similar trials, this study analyzed the accuracy and implications of clinical nodal positivity.

Methods: Patients ≥ 18 years old with cT1-T2, cN0-cN1, M0 breast cancer were identified in the National Cancer Database between 2004 and 2019.

Nodal Surgery for Patients ≥ 70 Undergoing Mastectomy for DCIS? Choose Wisely.

Background: Routine sentinel lymphadenectomy (SLNB) for early-stage HR+/HER2- breast cancer in women ≥70 is discouraged by Choosing Wisely, but whether SLNB can be routinely omitted in women ≥70 with DCIS undergoing mastectomy is unclear. This study aims to evaluate rates of axillary surgery and nodal positivity (pN+) in this population to determine the impact of axillary surgery on treatment decisions.

Methods: Females ≥70 with DCIS undergoing mastectomy were identified from the National Cancer Database (2012-2020).

Lost in Translation: Multilingual Analysis of Online Breast Cancer Information.

Introduction: Patients use the internet to learn more about health conditions. Non-English-speaking patients may face additional challenges. The quality of online breast cancer information, the most common cancer in women, is uncertain.

What Proportion of BRCA-Associated Breast Cancer Is Human Epidermal Growth Factor 2-Low and Eligible for Additional Targeted Therapy?

Introduction: DESTINY B04 provided clinical meaning to a new classification of human epidermal growth factor 2 (HER2) expression in breast cancer: HER2-low. Patients with germline breast cancer type 1 gene pathogenic variants (gBRCA1) often develop triple negative breast cancer (TNBC), but the proportion who could be classified as HER2-low and qualify for an additional targeted therapy option is unknown. This study aims to characterize the proportion of gBRCA1 or germline breast cancer type 2 gene pathogenic variants patients for whom these novel targeted therapies may be an option.

Update on Hypermetabolism in Pediatric Burn Patients.

Despite advancements in pediatric burn care, the profound hypermetabolic response associated with severe burns remains a multifaceted challenge throughout the continuum of care. Understanding the various physiologic disturbances that constitute hypermetabolism is crucial for a thorough evaluation and for implementing appropriate surgical and nonsurgical interventions. In this article, we describe the pathophysiology and treatment of hypermetabolism in pediatric burn patients with a focus on reducing resting energy requirements, minimizing infection, and optimizing nutrition for patients undergoing frequent surgical intervention.

Liposomal Bupivacaine Use During Orthognathic Surgery in Cleft Lip and Palate Patients.

Introduction: Effective pain management is crucial in cleft lip and palate (CLP) patients undergoing orthognathic surgery for earlier recovery and decreased opioid reliance. Liposomal bupivacaine (Exparel) is a local anesthetic that provides extended postoperative analgesia in adult patients; however, research on its use in adolescents is limited. This study explores the efficacy of liposomal bupivacaine for postoperative pain management in adolescent CLP patients undergoing orthognathic surgery.

Recent Advances in the Upfront Surgical Management of the Axilla in Patients with Breast Cancer.

Nodal status is an important prognostic indicator. Upfront axillary surgery for patients with breast cancer has historically been both diagnostic and therapeutic-serving to determine nodal status and inform adjuvant therapies, and to remove clinically significant disease. However, trials of de-escalation or omission of axillary surgery altogether consistently demonstrate noninferior oncologic outcomes in a wide variety of patient subsets.