To develop a new approach for interobserver variability analysis.
Eight radiation oncologists specializing in breast cancer radiation therapy delineated a patient's left breast "from scratch" and ...from a template that was generated using deformable image registration. Three of the radiation oncologists had previously received training in Radiation Therapy Oncology Group consensus contouring for breast cancer atlas. The simultaneous truth and performance level estimation algorithm was applied to the 8 contours delineated "from scratch" to produce a group consensus contour. Individual Jaccard scores were fitted to a beta distribution model. We also applied this analysis to 2 or more patients, which were contoured by 9 breast radiation oncologists from 8 institutions.
The beta distribution model had a mean of 86.2%, standard deviation (SD) of ±5.9%, a skewness of -0.7, and excess kurtosis of 0.55, exemplifying broad interobserver variability. The 3 RTOG-trained physicians had higher agreement scores than average, indicating that their contours were close to the group consensus contour. One physician had high sensitivity but lower specificity than the others, which implies that this physician tended to contour a structure larger than those of the others. Two other physicians had low sensitivity but specificity similar to the others, which implies that they tended to contour a structure smaller than the others. With this information, they could adjust their contouring practice to be more consistent with others if desired. When contouring from the template, the beta distribution model had a mean of 92.3%, SD ± 3.4%, skewness of -0.79, and excess kurtosis of 0.83, which indicated a much better consistency among individual contours. Similar results were obtained for the analysis of 2 additional patients.
The proposed statistical approach was able to measure interobserver variability quantitatively and to identify individuals who tended to contour differently from the others. The information could be useful as feedback to improve contouring consistency.
The authors previously compared the local tissue rearrangement, breast reduction, and latissimus dorsi flap reconstruction techniques for repairing partial mastectomy defects and showed the benefits ...of breast reduction.
In this study, the authors focused solely on factors influencing outcome in 41 patients who underwent repair of a partial mastectomy defect using breast reduction.
Tumor location had a significant effect on the design of the parenchymal pedicle (p = 0.05). Most repairs were performed with an inferior pedicle. Fifty percent of the lower outer and central quadrant tumors required an amputative design with a free nipple graft. The complication rates for immediate and delayed repair were 24 and 50 percent, respectively. The superior pedicle was associated with the highest complication rates. Tumors in the upper outer quadrant of the breast were associated with the highest complication rate (35 percent). Ninety percent of patients with planned repairs had a viable nipple-areola complex (p = 0.05) and did not require a free nipple graft. More favorable cosmetic outcomes were achieved using an inferior pedicle; less favorable cosmetic outcomes were achieved for tumors in the upper inner quadrant of the breast. Larger defects did not result in less favorable cosmetic outcomes than smaller defects. Only 7 percent of patients had a positive tumor margin. Five percent of patients developed local breast cancer recurrence after a mean follow-up of 36 months.
The authors provide practical guidelines for repairing a partial mastectomy defect using breast reduction that should minimize the occurrence of complications and optimize the cosmetic outcome.
Purpose of Review
Functional neurological disorder (FND) is a common and severely debilitating condition lacking clinical ownership, existing between neurology and psychiatry. This article reports ...the findings of recent research investigating the economic costs of FND diagnosis and management. We define what the costs are, why they exist, and suggest actionable steps to reduce them.
Recent Findings
The financial burden of FND exists across the globe characterized by high healthcare utilization resulting in exorbitant direct and indirect costs for the patient, healthcare system, and society. Inadequate medical education and stigmatization of the disorder prolong the time to diagnosis, during which cyclical utilization of inpatient and emergency department services drive up costs. Despite being cost-effective, lack of accessible treatment compounds the issue, leaving patients without a reliable exit.
Summary
Recent findings support an increased awareness and the need for a cultural shift to overcome the financial burden associated with this underserved population.
The purpose of this study was to determine local-regional recurrence (LRR) risk according to whether postmastectomy radiation therapy (PMRT) was used to treat breast cancer patients with clinical ...T3N0 disease who received neoadjuvant chemotherapy (NAC) and mastectomy.
Clinicopathology data from 162 patients with clinical T3N0 breast cancer who received NAC and underwent mastectomy were retrospectively reviewed. A total of 119 patients received PMRT, and 43 patients did not. The median number of axillary lymph nodes (LNs) dissected was 15. Actuarial rates were calculated using the Kaplan-Meier method and compared using the log-rank test.
At a median follow-up of 75 months, 15 of 162 patients developed LRR. For all patients, the 5-year LRR rate was 9% (95% confidence interval CI, 4%-14%). The 5-year LRR rate for those who received PMRT was 4% (95% CI, 1%-9%) vs. 24% (95% CI, 10%-39%) for those who did not receive PMRT (p <0.001). A significantly higher proportion of irradiated patients had pathology involved LNs and were ≤40 years old. Among patients who had pathology involved LNs, the LRR rate was lower in those who received PMRT (p <0.001). A similar trend was observed for those who did not have pathology involved LN disease. Among nonirradiated patients, the appearance of pathologic LN disease after NAC was the only clinicopathologic factor examined that significantly correlated with the risk of LRR.
Breast cancer patients with clinical T3N0 disease treated with NAC and mastectomy but without PMRT had a significant risk of LRR, even when there was no pathologic evidence of LN involvement present after NAC. PMRT was effective in reducing the LRR rate. We suggest PMRT should be considered for patients with clinical T3N0 disease.
Aims
. We report the discovery and characterisation of the transiting mini-Neptune HD 207496 b (TOI-1099) as part of a large programme that aims to characterise naked core planets.
Methods
. We ...obtained HARPS spectroscopic observations, one ground-based transit, and high-resolution imaging which we combined with the TESS photometry to confirm and characterise the TESS candidate and its host star.
Results
. The host star is an active early K dwarf with a mass of 0.80 ± 0.04
M
⊙
, a radius of 0.769 ± 0.026
R
⊙
, and a
G
magnitude of 8. We found that the host star is young, ~0.52 Gyr, allowing us to gain insight into planetary evolution. We derived a planetary mass of 6.1 ± 1.6
M
⊕
, a planetary radius of 2.25 ± 0.12
R
⊕
, and a planetary density of
ρ
p
= 3.27
−0.91
+0.97
g cm
−3
.
Conclusions
. From internal structure modelling of the planet, we conclude that the planet has either a water-rich envelope, a gas-rich envelope, or a mixture of both. We have performed evaporation modelling of the planet. If we assume the planet has a gas-rich envelope, we find that the planet has lost a significant fraction of its envelope and its radius has shrunk. Furthermore, we estimate it will lose all its remaining gaseous envelope in ~0.52 Gyr. Otherwise, the planet could have already lost all its primordial gas and is now a bare ocean planet. Further observations of its possible atmosphere and/or mass-loss rate would allow us to distinguish between these two hypotheses. Such observations would determine if the planet remains above the radius gap or if it will shrink and be below the gap.
Multidisciplinary guidelines for management of invasive breast carcinoma from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society ...of Surgical Oncology have been updated to reflect the continuing advances in the diagnosis and treatment of invasive breast cancer. The guidelines provide a framework for clinical decision‐making for patients with invasive breast carcinoma based on review of relevant literature and include information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.
Context.
Most of the currently known planets are small worlds with radii between that of the Earth and that of Neptune. The characterization of planets in this regime shows a large diversity in ...compositions and system architectures, with distributions hinting at a multitude of formation and evolution scenarios. However, many planetary populations, such as high-density planets, are significantly under-sampled, limiting our understanding of planet formation and evolution.
Aims.
NCORES is a large observing program conducted on the HARPS high-resolution spectrograph that aims to confirm the planetary status and to measure the masses of small transiting planetary candidates detected by transit photometry surveys in order to constrain their internal composition.
Methods.
Using photometry from the K2 satellite and radial velocities measured with the HARPS and CORALIE spectrographs, we searched for planets around the bright (
V
mag
= 10) and slightly evolved Sun-like star HD 137496.
Results.
We precisely estimated the stellar parameters,
M
*
= 1.035 ± 0.022
M
⊙
,
R
*
= 1.587 ± 0.028
R
⊙
,
T
eff
= 5799 ± 61 K, together with the chemical composition (e.g. Fe/H = −0.027 ± 0.040 dex) of the slightly evolved star. We detect two planets orbiting HD 137496. The inner planet, HD 137496 b, is a super-Mercury (an Earth-sized planet with the density of Mercury) with a mass of
M
b
= 4.04 ± 0.55
M
⊕
, a radius of R
b
= 1.31
−0.05
+0.06
R
⊕
, and a density of ρ
b
= 10.49
−1.82
+2.08
g cm
-3
. With an interior modeling analysis, we find that the planet is composed mainly of iron, with the core representing over 70% of the planet’s mass (M
core
/ M
total
= 0.73
−0.12
+0.11
). The outer planet, HD 137496 c, is an eccentric (
e
= 0.477 ± 0.004), long period (
P
= 479.9
−1.1
+1.0
days) giant planet (
M
c
sin
i
c
= 7.66 ± 0.11
M
Jup
) for which we do not detect a transit.
Conclusions.
HD 137496 b is one of the few super-Mercuries detected to date. The accurate characterization reported here enhances its role as a key target to better understand the formation and evolution of planetary systems. The detection of an eccentric long period giant companion also reinforces the link between the presence of small transiting inner planets and long period gas giants.
Data have suggested that the molecular features of breast cancer are important determinants of outcome; however, few studies have correlated these features with locoregional recurrence (LRR). In the ...present study, we evaluated estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) as predictors of LRR in patients with lymph node-negative disease and tumors < or = 1cm, because these patients often do not receive adjuvant chemotherapy or trastuzumab.
The data from 911 patients with stage T1a,bN0 breast cancer who had received definitive treatment at our institution between 1997 and 2002 were retrospectively reviewed. We prospectively analyzed ER/PR/HER2 expression from the archival tissue blocks of 756 patients. These 756 patients represented the cohort for the present study.
With a median follow-up of 6.0 years, the 5- and 8-year Kaplan-Meier LRR rate was 1.6% and 5.9%, respectively, with no difference noted in those who underwent breast conservation therapy vs. mastectomy (p=.347). The 8-year LRR rates were greater in the patients with ER-negative (10.6% vs. 4.2%, p=.016), PR-negative (9.0% vs. 4.2%, p=.009), or HER2-positive (17.5% vs. 3.9%, p=0.009) tumors. On multivariate analysis, ER-negative and PR-negative disease (hazard ratio, 2.37; p=.046) and HER2-positive disease (hazard ratio, 3.13, p=.016) independently predicted for LRR.
Patients with ER/PR-negative or HER2-positive T1a,bN0 breast cancer had a greater risk of LRR. Therapeutic strategies, such as the use of chemotherapy and/or anti-HER2 therapies, should be considered for future clinical trials for these patients.
The aims of this study were to determine outcomes for patients with inflammatory breast cancer (IBC) treated with multimodality therapy, to identify factors associated with locoregional recurrence, ...and to determine which patients may benefit from radiation dose escalation.
We retrospectively reviewed 256 consecutive patients with nonmetastatic IBC treated at our institution between 1977 and 2004.
The 192 patients who were able to complete the planned course of chemotherapy, mastectomy, and postmastectomy radiation had significantly better outcomes than the 64 patients who did not. The respective 5-year outcome rates were: locoregional control (84% vs. 51%), distant metastasis-free survival (47% vs. 20%), and overall survival (51% vs. 24%) (p < 0.0001 for all comparisons). Univariate factors significantly associated with locoregional control in the patients who completed plan treatment were response to neoadjuvant chemotherapy, surgical margin status, number of involved lymph nodes, and use of taxanes. Increasing the total chest-wall dose of postmastectomy radiation from 60 Gy to 66 Gy significantly improved locoregional control for patients who experienced less than a partial response to chemotherapy, patients with positive, close, or unknown margins, and patients <45 years of age.
Patients with IBC who are able to complete treatment with chemotherapy, mastectomy, and postmastectomy radiation have a high probability of locoregional control. Escalation of postmastectomy radiation dose to 66 Gy appears to benefit patients with disease that responds poorly to chemotherapy, those with positive, close, or unknown margin status, and those <45 years of age.
The number of super-Earth and mini-Neptune planet discoveries has increased significantly in the last two decades thanks to transit and radial velocity (RV) surveys. When it is possible to apply both ...techniques, we can characterise the internal composition of exoplanets, which in turn provides unique insights on their architecture, formation and evolution. We performed a combined photometric and RV analysis of TOI-238 (TYC 6398-132-1), which has one short-orbit super-Earth planet candidate announced by NASA’s TESS team. We aim to confirm its planetary nature using radial velocities taken with the ESPRESSO and HARPS spectrographs, to measure its mass, and to detect the presence of other possible planetary companions. We carried out a joint analysis by including Gaussian processes and Keplerian orbits to account for the stellar activity and planetary signals simultaneously. We detected the signal induced by TOI-238 b in the RV time series, and the presence of a second transiting planet, TOI-238 c, whose signal appears in RV and TESS data. TOI-238 b is a planet with a radius of 1.402 −0.086 +0.084 R ⊕ and a mass of 3.40 −0.45 +0.46 M ⊕ . It orbits at a separation of 0.02118 ± 0.00038 au of its host star, with an orbital period of 1.2730988 ± 0.0000029 days, and has an equilibrium temperature of 1311 ± 28 K. TOI-238 c has a radius of 2.18 ± 0.18 R ⊕ and a mass of 6.7 ± 1.1 M ⊕ . It orbits at a separation of 0.0749 ± 0.0013 au of its host star, with an orbital period of 8.465652 ± 0.000031 days, and has an equilibrium temperature of 696 ± 15 K. The mass and radius of planet b are fully consistent with an Earth-like composition, making it a likely rocky super-Earth. Planet c could be a water-rich planet or a rocky planet with a small H-He atmosphere.
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