Eldaly, Abdullah S.

Background: Breast cancer is the most common malignancy and the second most common cause of death in women worldwide. Axillary lymph node metastasis (ALNM) is the most significant prognostic factor in breast cancer. Under the current guidelines, sentinel lymph node biopsy (SLNB) is the standard of axillary staging in patients with clinically-node negative breast cancer. Despite the minimally invasive nature of SLNB, it can cause short and long-term morbidities including pain, sensory impairment, and upper limb motor dysfunction. However, lymphedema remains the most feared adverse event, and it affects 7% of patients within 36 months of follow-up. Recently, we have witnessed the implication of radiomics and artificial intelligence domains in the diagnosis and follow-up of many malignancies with promising results. Therefore, we have conducted a systematic search to investigate the potentials of radiomics and artificial intelligence in predicting ALNM. Methods: Four electronic databases were searched: PubMed, Scopus, CINAHL, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization. Results: For radiomics, area under the curve (AUC) for the included studies ranged from 0.715 to 0.93. Accuracy ranged from 67.7% to 98%. Sensitivity and specificity ranged from 70.3% to 97.8% and 58.4% to 98.2%, respectively. For other artificial intelligence methods, AUC ranged from 0.68 to 0.98, while accuracy ranged from 55% to 89%. Conclusion: The results of radiomics and artificial intelligence in predicting ALNM are promising. However, validation as a substitute to SLNB requires more substantial evidence from large randomized trials.

Abstract Background: Endocrine therapy (ET) reduces breast cancer (BC) recurrence risk and improves BC outcomes. However, patients (pts) may refuse ET, potentially impacting their outcomes. However, the exact incidence and factors associated with ET refusal are largely unknown. Methods: We conducted a retrospective study of BC pts in the National Cancer Data Base between 2003 and 2017. Demographic, socioeconomic, co-morbidity index and tumor-specific data were compared between BC pts who refused ET versus those who agreed to ET using bivariate and multivariate models. Female pts 18 to 89 years of age with stage I, II, and III were included. Logistic regression was used to determine associations with ET refusal. Results: Among 463,228 pts, the incidence of ET refusal was 5.26% (24, 401). Of these pts, 85% were non-Hispanic White, 7.9% were Non-Hispanic Black, 3.1% non-Hispanic Asian/pacific islander, and 3.6% were Hispanic. A majority (56.9%) had government insurance, and 87.2% were from a metro residential area. Infiltrating ductal carcinoma BC subtype comprised 78% of pts. Most pts were 51-89 years of age (80%), and 20% were 18-50 years of age. On multivariable analysis (Table 1), non-Hispanic black (OR 0.82), non-Hispanic Asian (OR 0.72), and Hispanic (OR 0.84) pts had a reduced odds of refusing ET than non-Hispanic white pts. Pts with government insurance (OR 1.6, p<0.001) and noninsured pts (OR 1.3, p<0.001) had increased odds of refusing ET compared to privately insured pts. Estrogen receptor (ER) -/Progesterone (PR) +, and ER +/PR - had increased odds of refusing therapy (OR 2.9, and 1.1 respectively, p<0.001) than ER +/PR + pts. Patients with positive lymph nodes had reduced odds of refusing ET than those with negative lymph nodes (p<0.001). Additionally, pts with a 2.1-5 cm (OR 0.92) or >5 cm (OR 0.87) tumor size had a reduced odd of refusing ET than those with tumors less than 2 cm (p<0.001). Finally, patients with well-differentiated BC (grade I) had increased odds of refusing ET (OR 1.2, p<0.001) than moderately differentiated (grade II) BC. Conclusions: The incidence of ET therapy refusal is relatively low; however, survival outcomes may be negatively impacted. This is the first study to evaluate specific demographic and disease-specific factors associated with ET refusal, which can inform strategies to improve ET acceptance rate. Table 1.Multivariable Logistic Regression – ET Therapy Acceptance (Referent) vs. Refusal.VariableOR95% CIp-valueAge51 - 89 years18 - 50 years0.940.900.970.001Race/EthnicityWhite Non-HispanicBlack Non-Hispanic0.820.760.88<0.001Pacific Islander Non-Hispanic0.720.660.76<0.001Hispanic0.840.790.87<0.001InsurancePrivateGovernment1.61.521.61<0.001Not insured1.31.181.47<0.001ResidenceMetroUrban0.900.870.87<0.001Rural0.870.780.970.014HistologyInfiltrating ductal carcinomaLobular carcinoma0.840.800.87<0.001Infiltrating duct and lobular carcinoma0.900.850.95<0.001Others1.171.101.24<0.001Positive Nodes01 - 30.620.600.65<0.0014 - 90.610.570.66<0.00110 +0.610.550.68<0.001VariableOR95% CIp-valueER/PR ExpressionER +/PR +ER -/PR +2.92.563.18<0.001ER +/PR -1.11.061.14<0.001Tumor size≤ 2 cm2.1 - 5 cm0.920.880.94<0.001> 5 cm0.870.800.93<0.001GradeIII1.211.181.25<0.001III0.980.951.020.518Charlson-Deyo Score010.940.910.980.00421.070.991.150.071≥31.120.981.280.079 Citation Format: Pooja P Advani, Ricardo Torres Guzman, Francisco Avila Verduzco, Karla Maita, John Garcia, Abdullah Eldaly, Antonio Forte, Aaron Spaulding. Factors associated with endocrine therapy refusal in hormone receptor-positive breast cancer patients [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 P5-14-16.

An 85-year-old male presented to the podiatry clinic following a 1st to 5th left toe amputation as a complication of severe peripheral arterial disease and nonhealing wound despite endovascular intervention with an angiogram. At the visit, cellulitis with gangrene of the surgical site was noted. The patient was admitted to the brick and mortar (BAM) hospital and taken to surgery for a transmetatarsal amputation of the left limb. In the immediate postoperative period, the incisional margins appeared dusky creating concern for flap viability. The medical team recommended a vascular bypass versus a below-knee amputation. However, given the age, comorbidities, and nutritional status, the family refused further surgical intervention. As such, Mayo Clinic’s home hospital program, Advanced Care at Home (ACH), was consulted for continued nonsurgical acute management at home. The patient was transferred to ACH and transported home three days after BAM admission to continue IV antibiotic therapy and wound care. Discharge from ACH occurred 11 days after admission to the BAM hospital. This case highlights the importance of developing health care alternatives to traditional hospitalization and demonstrates that ACH can manage highly complex, elder postoperative patients from the comfort of their homes.