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1.
Ann Surg Oncol ; 31(12): 8086-8092, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-39110348

RESUMEN

BACKGROUND: Concrete, data-driven guidelines for breast cancer screening among the transgender and gender diverse (TGD) population is lacking. The present study evaluates possible associations of gender-affirming hormone therapy (GAHT) on incidental breast pathology findings in trans-masculine patients to inform decision making about breast cancer screening. PATIENTS AND METHODS: This was a retrospective cohort study of patients who had gender-affirming mastectomy or breast reduction at a single center from July 2019 to February 2024. A total of 865 patients met the inclusion criteria. Gender-affirming testosterone therapy and length of exposure were evaluated to seek differences in post-operative pathology findings. RESULTS: The median age at the time of surgery was 27 years [interquartile range (IQR) 21-30]. Most participants identified as female to male (658, 75.6%). A significant portion of the participants (688, 79.2%) were undergoing testosterone therapy at the time of surgery, with the median duration of testosterone use prior to surgery being 14 months (IQR 4-29). High risk or malignant findings were noted in pathology results for 12 of 1730 breasts (0.7%). Ordered logistic regression found that duration of testosterone therapy was not associated with increasing severity of incidental breast pathology. Additionally, patients under 25 years of age were 70% less likely to have any incidental finding on pathological evaluation than older patients [odds ratio (OR) 0.3, p < 0.01, confidence interval (CI) 0.18-0.50]. CONCLUSIONS: The present study found that patients undergoing GAHT should not be screened for breast cancer with increased frequency compared with cis-gender women. Additionally, it may be appropriate for trans women under the age of 25 with normal breast cancer risk to forego pathological breast tissue examination.


Asunto(s)
Neoplasias de la Mama , Mastectomía , Testosterona , Personas Transgénero , Humanos , Femenino , Personas Transgénero/estadística & datos numéricos , Estudios Retrospectivos , Masculino , Mastectomía/efectos adversos , Adulto , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Adulto Joven , Incidencia , Estudios de Seguimiento , Pronóstico , Cirugía de Reasignación de Sexo , Factores de Riesgo , Hallazgos Incidentales , Procedimientos de Reasignación de Sexo/efectos adversos , Persona de Mediana Edad
3.
J Surg Educ ; 81(2): 219-225, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38172040

RESUMEN

OBJECTIVE: To determine if senior residents are comparable to faculty in assessing first-year resident skills on their overall assessment. BACKGROUND: As resident training moves towards a competency-based model, innovative approaches to evaluation and feedback through simulation need to be developed for both procedural as well as interpersonal and communication skills. In most areas of simulation, the faculty assess resident performance however; in clinical practice, first-year residents are often overseen and taught by senior residents. We aim to explore the agreement between faculty and senior resident assessors to determine if senior residents can be incorporated into a competency-based curriculum as appropriate evaluators of first-year resident skills. DESIGN: Annual surgical first year resident training for central line placement, obtaining informed consent and breaking bad news at a single institution is assessed through an overall assessment (OA). In previous years, only faculty have been the evaluators for the OA. In this study, select senior residents were asked to participate as evaluators and agreement between groups of evaluators was assessed across the 3 tasks taught during surgical first-year resident training. SETTING: Vanderbilt University Medical Center, tertiary hospital, Simulation Center. PARTICIPANTS: Anesthesia and surgery interns, chief residents, anesthesia and surgical faculty. RESULTS: Agreement between faculty and senior resident assessors was strongest for the central line placement simulation with a faculty average competency score of 10.71 and 9.59 from senior residents (κ = 0.43; 95% CI: -0.2, 0.34). Agreement was less substantial for simulated informed consent (κ = 0.08; 95% CI: -0.19, 0.36) and the breaking bad news simulation (κ = 0.07; 95% CI: -0.2, 0.34). CONCLUSION: Select senior residents are comparable to faculty evaluators for procedural competency; however, there was less agreement between evaluator groups for interpersonal and communication-based competencies.


Asunto(s)
Internado y Residencia , Humanos , Educación de Postgrado en Medicina , Curriculum , Docentes , Centros Médicos Académicos , Competencia Clínica , Docentes Médicos
4.
Aesthet Surg J ; 44(3): NP209-NP217, 2024 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-37995314

RESUMEN

BACKGROUND: Although legislation prohibiting gender identity discrimination in health insurance has shown some improvement in insurance coverage for gender-affirming surgery (GAS), recent bills criminalizing GAS providers in the South and Midwest regions pose threats to patient care. OBJECTIVES: To investigate the influence of US census region on patient demographics and GAS rates in the ambulatory surgery setting. METHODS: Individuals with gender dysphoria who underwent GAS in the ambulatory setting from 2016 to 2019 were identified in the Nationwide Ambulatory Surgery Sample (NASS) with billing codes. Demographic and clinical characteristics were analyzed and stratified by US census region. RESULTS: The data set included a weighted estimate of 33,174 encounters with 72.8% (95% CI, 69.1-76.2) for chest reconstruction; 24.1% (95% CI, 20.9-27.5) for surgery on the genitals and reproductive organs; and 6.0% (95% CI, 4.6-7.8) for facial surgery. Overall, the rates of GAS increased by 187%, from 4320 encounters in 2016 to 12,396 encounters in 2019. In the Midwest, GAS increased by 257% compared to 203% in the Northeast, 218% in the South, and 154% in the West. Compared to patients in the West, those in other regions had higher odds of anxiety and depression (odds ratio, 1.57; 95% CI, 1.09-2.26; P < .05) and were more likely to have lower incomes than other ambulatory surgery patients in the region (P < .001). CONCLUSIONS: Between 2016 and 2019, there was substantial growth of GAS in the Midwest, South, and Northeast. Regional differences in insurance coverage, socioeconomic status, availability of facial surgery, and comorbidities were observed.


Asunto(s)
Cirugía de Reasignación de Sexo , Humanos , Masculino , Femenino , Estados Unidos/epidemiología , Identidad de Género , Demografía
5.
Am Surg ; 89(8): 3528-3530, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-36876329

RESUMEN

Anastomosing hemangiomas (AH) are rare benign masses. We report an occurrence of AH in the breast during pregnancy, its pathological analysis, and clinical management. Key in the evaluation of these rare vascular lesions is differentiating AH from angiosarcoma. A low proliferative Ki-67 index and small size on imaging and final pathology will confirm AH from angiosarcoma. Clinical management of AH requires surgical resection and standard interval mammography and clinical breast examination.


Asunto(s)
Hemangioma , Hemangiosarcoma , Humanos , Embarazo , Femenino , Hemangiosarcoma/diagnóstico , Hemangioma/diagnóstico por imagen , Hemangioma/cirugía , Mamografía
6.
J Surg Oncol ; 127(1): 18-27, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36069388

RESUMEN

BACKGROUND: Sentinel node biopsy (SLNB) is not routinely recommended for patients undergoing prophylactic mastectomy (PM), yet omission remains a subject of debate among surgeons. A modern patient cohort was examined to determine occult malignancy (OM) incidence within PM specimens to reinforce current recommendations. METHODS: All PM performed over a 5-year period were retrospectively identified, including women with unilateral breast cancer who underwent synchronous or delayed contralateral PM or women with elevated cancer risk who underwent bilateral PM. RESULTS: The study population included 772 patients (598 CPM, 174 BPM) with a total of 39 OM identified: 17 invasive cancers (14 CPM, 3 BPM) and 22 DCIS (19 CPM, 3 BPM). Of the 86 patients for whom SLNB was selectively performed, 1 micrometastasis was identified. In the CPM cohort, risk of OM increased with age, presence of LCIS of either breast, or presence of a non-BRCA high-penetrance gene mutation, while preoperative magnetic resonance imaging was associated with lower likelihood of OM. CONCLUSIONS: Given the low incidence of invasive OM in this updated series, routine SLNB is of low value for patients undergoing PM. For patients with indeterminate radiographic findings, discordant preoperative biopsies, LCIS, or non-BRCA high-penetrance gene mutations, selective SLNB implementation could be considered.


Asunto(s)
Neoplasias de la Mama , Neoplasias Primarias Desconocidas , Mastectomía Profiláctica , Humanos , Femenino , Mastectomía , Estudios Retrospectivos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/genética , Neoplasias de la Mama/prevención & control , Biopsia del Ganglio Linfático Centinela , Neoplasias Primarias Desconocidas/diagnóstico por imagen , Neoplasias Primarias Desconocidas/cirugía
7.
J Surg Oncol ; 125(8): 1218-1223, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35230701

RESUMEN

BACKGROUND AND OBJECTIVES: Given the significant benefit of targeted therapies for HER2+ breast cancer patients in both the neoadjuvant and adjuvant settings, it is critical to identify all eligible patients for these treatments. We sought to investigate cT1cN0 HER2+ patients to determine the rate of postsurgical nodal positivity, and to identify presurgical factors associated with nodal positivity. We hypothesize there is a subset of underdiagnosed HER2+ patients who would benefit from preoperative axillary imaging and inclusion in neoadjuvant chemotherapy regimens. METHODS: We performed a 10-year retrospective analysis of T1 HER2+ breast cancer patients. Clinicopathologic characteristics were evaluated based on surgical nodal data. RESULTS: We identified 38 patients with cT1cN0 HER2+ cancer. Of this cohort, 24% had positive lymph nodes on final pathology. High tumor grade (p = 0.035) on core needle biopsy and the presence of lymphovascular invasion (p = 0.0036) were associated with an increased likelihood of lymph node positivity. The majority (66%) of lymph node positive patients were clinically T1c. CONCLUSIONS: We identified a 24% nodal positivity rate in clinically node negative T1 HER2+ breast cancer patients. In particular, HER2+ patients with high-grade T1c cancers should undergo preoperative diagnostic axillary imaging to expand potential benefit from targeted therapies.


Asunto(s)
Neoplasias de la Mama , Axila/patología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/terapia , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática/patología , Terapia Neoadyuvante , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela/métodos
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