Citations

Abstract Background: Intra-operative identification of positive margins and lymph nodes continues to be a challenge for breast cancer surgeons. Current techniques such as frozen section or touch prep cytology are time consuming and vary in accuracy across institutions. Our study is the first part of a phase 2 trial of a systemically administered, ratiometric, activatable, cell-penetrating fluorescent peptide dye conjugate that visualizes breast cancer tumor tissue in vivo and ex vivo. We hypothesized that this method would be able to identify breast cancer close to the margin of lumpectomy specimens. Methods: AVB-620 is a cell penetrating peptide-fluorescent imaging agent which undergoes proteolytic cleavage by proteases in the matrix metalloproteinase family that have higher activity in cancerous tissue. After cleavage, the predominant fluorescent emission wavelength changes and fluorescent intensity increases, generating a ratiometric readout. AVB-620 was administered 3- 24 hours prior to operation via intravenous infusion to stage 0-III breast cancer patients. Patients were monitored for safety followed by primary breast surgery and either sentinel lymph node biopsy (SLNB) with radiotracer only or axillary lymph node dissection (ALND). Using a near-infrared camera system, fluorescent intensity of two wavelengths was measured intraoperatively both in vivo and ex vivo, including primary tumors, shave margins, and lymph nodes. The ratio of the intensity of these two wavelengths was utilized to distinguish between malignant and non-malignant tissues and visualized on a video monitor. Pathology reports were correlated to a computer-assisted human review of the fluorescent images. Results: Thirty-two patients were dosed without adverse events attributable to the agent; 31 were evaluable for fluorescent imaging. The average age of patients was 60 years (range 32-79). All patients underwent lumpectomy and axillary surgery. Two patients received neoadjuvant chemotherapy; 10% of patients had pure DCIS tumors. Among invasive tumors: 94% were ER+; 13% were high grade. All primary tumor images demonstrated fluorescent intensity and ratiometric changes that differentiated malignant and non-malignant tissue. 35% of patients had at least one positive margin (invasive tumor on ink or DCIS ≤2mm from ink). 61% of cases had at least one margin that was considered either close (≤2mm from ink for invasive tumor) or positive on H&E staining. 84% of patients with positive/close margins were identified utilizing fluorescent imaging. Four of the 5 patients with positive nodes had a positive fluorescent image. Discussion: These results demonstrate the ability of AVB-620 to identify and visualize malignant tumor and lymph nodes intraoperatively, illustrating the potential of such a tool to decrease reoperation rates. The second part of this phase II study is underway where intraoperative fluorescent imaging will be utilized to guide removal of additional shave margins. Citation Format: Chen SL, Baron PL, Lee MC, Feldman SM, McLaughlin SA, Terando AM, Harootunian A, Poonka P, Gonzalez JE. Use of an activatable cell penetrating peptide-fluorescent imaging agent (AVB-620) to identify positive and close margins intraoperatively [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-07.

Abstract Lymphedema (LE) is a common but underreported complication of breast cancer treatment since most studies lack baseline and follow-up measurements or follow-up that is long enough to adequately record true incidence. Contemporary prospective randomized trials continue to document the occurrence of lymphedema after any axillary treatment and note that combination therapy with axillary surgery and radiation nearly doubles LE risk. Over the last 5 years clinicians have witnessed a paradigm shift in the diagnostic practices of LE with concerted efforts focusing on early detection as opposed to reactionary interventions. Controversy however has existed over how to define and diagnose LE and as such the literature surrounding diagnosis is heterogeneous with respect to incidence and recommendations. Existing guidelines emphasize the need for routine monitoring for LE and the critical importance of baseline, bilateral, and longitudinal limb assessments but do not embrace one measurement technique. A growing body of prospective observational data is systematically challenging the value of precautionary behaviors. Further, prospective randomized data demonstrates exercise does not promote the development of LE. Complex decongestive therapy remains the cornerstone of non-surgical LE treatment. With the NCI predicting over 4 million breast cancer survivors in the US by 2024, lymphedema is potentially a significant public health burden. Citation Format: McLaughlin S. Current status of diagnosis, monitoring, and non-surgical management of lymphedema [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr ES11-2.

Background Preoperative planning software has been developed to measure glenoid version, glenoid inclination, and humeral head subluxation on computed tomography (CT) for shoulder arthroplasty. However, most studies analyzing the effect of glenoid positioning on outcome were done prior to the introduction of planning software. Thus, measurements obtained from the software can only be extrapolated to predict failure provided they are similar to classic measurements. The purpose of this study was to compare measurements obtained using classic manual measuring techniques and measurements generated from automated image analysis software. Methods Ninety-five two-dimensional computed tomography scans of shoulders with primary glenohumeral osteoarthritis were measured for version according to Friedman method, inclination according to Maurer method, and subluxation according to Walch method. DICOM files were loaded into an image analysis software (Blueprint, Wright Medical) and the output was compared with values obtained manually using a paired sample t-test. Results Average manual measurements included 13.8° version, 13.2° inclination, and 56.2% subluxation. Average image analysis software values included 17.4° version (3.5° difference, p < 0.0001), 9.2° inclination (3.9° difference, p < 0.001), and 74.2% for subluxation (18% difference, p < 0.0001). Conclusions Glenoid version and inclination values from the software and manual measurement on two-dimensional computed tomography were relatively similar, within approximately 4°. However, subluxation measurements differed by approximately 20%.

Background Education opportunities for night shift nurses are limited compared with those for their day-shift counterparts. However, patients remain critically ill regardless of shift and require intensive nursing care at all hours. Overnight, this care is often provided with fewer resources. These challenges can lead to disengagement and high turnover on the night shift. Objectives To see whether initiation of an informal education series called “Coffee Talk” could improve accessibility to learning for night shift nurses and elevate perception of support from administrators and overall job satisfaction. Methods The lecture series was created to facilitate education for night shift nurses. The program features various speakers within the interdisciplinary team discussing topics chosen by the nursing staff. The talks are presented in an informal setting during overnight hours. An electronic survey tool was used to determine nurses’ opinions regarding Coffee Talk, using a retrospective pretest and posttest format. Questions centered on the type of educational offerings, relevance to practice, perceived leadership support, convenience of attendance, and overall job satisfaction. Results More than half of the nurses (59%) responded. All scores improved from before to after the intervention. The largest increases occurred in convenience of educational offerings and nurses’ perception of leaders removing barriers to learning. Overall job satisfaction increased from 83% to 93%. Conclusions The introduction of an informal educational series improved nurses’ access to education and nurses’ feelings of support from administrators and overall job satisfaction.