ACGME 2011 duty-hour guidelines: consequences expected by radiology residency directors and chief residents.

PURPOSE: The aim of this study was to assess perceptions of the 2011 ACGME duty-hour guidelines among radiology residency directors and chief residents with regard to resident training, the practice of radiology, the quality of resident life, and faculty and staff costs. METHODS: An online survey was sent to radiology program directors and chief residents via the Association of University Radiologists. RESULTS: The response rates were 36.7% for program directors and 18.6% for chief residents. Responses were generally weakly negative from both radiology program directors and chief residents. CONCLUSIONS: Both radiology program directors and chief residents have negative perceptions of the effect of the 2011 ACGME duty-hour guidelines on radiology residency programs. There was significant disagreement between program directors and chief residents with regard to whether attending radiologists or residents would be more affected by the new guidelines.

Impact of MRI-evaluated neoadjuvant chemotherapy response on change of surgical recommendation in breast cancer.

OBJECTIVE: To investigate how MRI imaging of neoadjuvant chemotherapy (NAC) tumor response affects the recommendation for optimal breast cancer surgery, both before and after NAC. SUMMARY BACKGROUND DATA: Understanding how imaging findings are incorporated into surgeons' decision-making processes will help establish appropriate imaging guidelines for recommending breast conservation surgery (BCS) after the NAC. METHODS: Seventy-six breast cancer patients undergoing NAC with MRI follow-up studies were analyzed. Two experienced breast surgeons reviewed all cases. An initial surgical recommendation was made based on the pre-NAC lesion presentation; a subsequent surgical recommendation was made based on the post-NAC tumor response. Finally, the pathology results were disclosed and the surgeons were asked to decide on the optimal definitive surgical procedure. MRI findings throughout the entire course of the NAC were analyzed to understand how they affected different recommendations. RESULTS: Before the NAC, a large tumor size or extent of disease were the primary determinant factors for mastectomy. In this study, the mean tumor size was 5.3 +/- 3.4 cm (RECIST) in the mastectomy group and 3.2 +/- 1.6 cm in the lumpectomy group (P = 0.0001). After the NAC, based on consensus recommendations, 21 mastectomy candidates remained for mastectomy, with tumor size decreasing from 7.4 +/- 4.5 to 1.5 +/- 2.5 cm, and 22 mastectomy candidates were changed to lumpectomy, with tumor size decreasing from 4.2 +/- 2.1 to 0.4 +/- 0.6 cm. When the final pathology revealed pCR or minimal residual disease, the surgeons agreed that BCS is the optimal procedure. On the other hand, for a large extent of residual disease, mastectomy should be performed. CONCLUSION: In patients who had more extensive pretreatment disease, despite an excellent response to NAC, the surgeons still tended to apply an aggressive approach and recommended mastectomy. Given that the confirmation of pCR or minimal residual disease would change surgeons' recommendations for less aggressive, conservation surgery, the maturity of MRI for NAC response prediction may provide reliable staging information to aid in the recommendation of the optimal surgical procedure.

MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy.

BACKGROUND: This study investigated the role of magnetic resonance imaging (MRI) in evaluation of pathologically complete response and residual tumors in patients who were receiving neoadjuvant chemotherapy (NAC) for both positive and negative HER-2 breast cancer. METHODS: Fifty-one individuals, comprised of 25 HER-2 positive and 26 HER-2 negative patients, were included in the study. Serial MRI studies were acquired before, during, and after NAC. On the basis of the final MRI, response was determined to be a clinically complete response ([CCR], no enhancement), probable CCR (residual enhancement equal to or less than that of glandular tissue), or residual tumor. All patients received surgery. Pathological outcomes were categorized as 1) no residual cancer, 2) no residual invasive cancer but ductal carcinoma in situ (DCIS) present, or 3) residual invasive cancer. The pathologically complete response (pCR) was defined as no invasive cancer. RESULTS: Complete clinical response as seen through MRI, including CCR and probable CCR, was identified in 35 (35 of 51, 69%) patients. MRI correctly diagnosed pCR in 26 (26 of 35, 74%) patients, including 18 of 19 (95%) patients in the HER-2 positive group and 8 of 16 (50%) patients in the HER-2 negative group (P < .005). The accuracy of MRI in identifying pCR varied according to the chemotherapy agent that was administered. MRI was more accurate in identifying pCR in patients who were receiving trastuzumab and less accurate in patients receiving bevacizumab. The high false-negative rate found in HER-2 negative patients was associated with residual disease that presented as scattered cells or small foci. In cases with residual bulk tumor, the lesion size, determined by MRI, correlated highly with that found in histopathological measurements (r = 0.93). CONCLUSIONS: MRI may predict pCR with high accuracy in HER-2 positive patients, but it has a high false-negative rate in HER-2 negative patients, particularly in patients who are receiving antiangiogenic agents. Results indicate that the chemotherapy agent should be taken into consideration when using MRI to interpret therapeutic outcomes. More studies are needed to establish the role of MRI in managing, especially surgical planning, patients who are receiving NAC.

Restoration of receptor-type protein tyrosine phosphatase eta function inhibits human pancreatic carcinoma cell growth in vitro and in vivo.

DEP-1/HPTPeta, a receptor-type protein tyrosine phosphatase, is a candidate tumor suppressor gene because its expression was blocked in rat and human thyroid transformed cells, and its restoration reverted their neoplastic phenotype. In addition, loss of DEP-1/HPTPeta heterozygosity has been described in mammary, lung and colon primary tumors. We now show that DEP-1/HPTPeta is drastically reduced in several cell lines originating from human epithelial pancreatic carcinomas compared with normal pancreatic tissue. We also show that the infection of AsPC1 and PSN1 cells with a recombinant adenovirus carrying r-PTPeta cDNA (the rat homolog of DEP-1/HPTPeta) inhibits their proliferation. Flow cytometric analysis of the infected cells demonstrated that restoration of r-PTPeta activity disrupts their cell cycle and leads to apoptosis. Finally, the growth of PSN1 xenograft tumors was blocked by the intratumoral injection of a recombinant adeno-associated virus carrying r-PTPeta. The data suggest that restoration of DEP-1/HPTPeta expression could be a useful tool for the gene therapy of human pancreatic cancers.