Synchronous Bilateral Breast Cancer: A Case Report Piloting and Evaluating the Implementation of the AI-Powered Large Language Model (LLM) ChatGPT.

Primary breast carcinoma is the most common cancer type in women, and although bilateral synchronous breast cancers (s-BBC) remain quite rare, the reported incidence may increase with the adoption of more sensitive imaging modalities. Here, we present a case of histomorphological and clinically distinct s-BBC, together with a discussion of clinical management decisions, prognosis, and treatment standards and how these relate to outcomes vis-à-vis more established standards in unifocal breast carcinoma. The case report also constitutes a pilot and formal evaluation of a large language model (LLM) of ChatGPT as a tool to aid in generating a single patient case report.

Use of Reduced Activity Seeds in Breast Radioactive Seed Localization.

Radioactive seed localization procedures, using I seeds of typical activity 3.7 MBq and higher, are performed to localize nonpalpable lesions in the breast for surgical excision and pathology analysis. This study evaluated the use and dosimetry of I seeds of activity <3.7 MBq in radioactive seed localization procedures through retrospective health record review, Monte Carlo simulation, and experimental detection. An average seed strength at the time of specimen excision of 2.48 ± 0.629 MBq was used in 295 radioactive seed localization procedures at Gundersen Health System in La Crosse, Wisconsin, US. The average explanted seed activity served as a basis for Monte Carlo simulation of an I IsoAid Advantage seed embedded in soft tissue, which scored the dose deposited to soft tissue. Tabulated values of the dose to postsurgical residual tissue as a function of explanted tumor radius were shown and compared with previously published results. Use of seeds of activity from 1.44 to 3.7 MBq at the time of excision did not adversely affect seed detection and excision. The absorbed dose to residual tissue calculated using Monte Carlo was an average of 1.4 times larger than previously published results when scaled to identical seed strengths. This study demonstrates that seeds of activity <3.7 MBq can be used for radioactive seed localization procedures with no loss in efficacy and a benefit of reduced radiation dose to patients. This is important because the estimated radiation dose to residual tissue is approximately 1.4 times higher than previously indicated.

Impact of the SSO-ASTRO Margin Guideline on Rates of Re-excision After Lumpectomy for Breast Cancer: A Meta-analysis.

BACKGROUND: One in five patients undergoing initial lumpectomy for invasive breast cancer subsequently undergoes re-excision or mastectomy. A lack of clarity of when to re-excise based on lumpectomy margin width contributes to this high rate of reoperation. We sought to determine the impact of the Society of Surgical Oncology (SSO) and American Society of Radiation Oncologist (ASTRO) margin guideline on reoperation rates after lumpectomy. The guideline recommended omission of routine re-excision in specimens with "no ink on tumor". METHODS: A systematic literature review was performed. For eligible studies, a random-effects model was used for a meta-analysis of lumpectomy re-excision prevalence before and after publication of the SSO-ASTRO margin guideline. Study heterogeneity was measured by the Cochran's Q test. RESULTS: Five institutional, one population-based, and one national registry study met inclusion requirements. Sample size per study ranged from 237 to 26,102. There was significant interstudy heterogeneity (Q = 19.779; p = 0.003). Pooled re-excision prevalence was 22% (confidence interval [CI] 20-23) before and 14% (CI 12-15) after guideline publication. With the pre-guideline re-excision prevalence used as the reference value, the associated odds ratio for re-excision after the guideline was 0.65 (CI 0.54-0.78; p < 0.0001). CONCLUSIONS: The findings of a 35% reduction in the odds of re-excision after the guideline publication and a reduction in re-excision prevalence from 22 to 14% supports the notion that the SSO-ASTRO margin guideline was impactful. These findings are congruent with the projected reductions in re-excision at the time of guideline publication.

Update of the American Society of Breast Surgeons Toolbox to address the lumpectomy reoperation epidemic.

In 2015, the American Society of Breast Surgeons (ASBrS) convened a multidisciplinary consensus conference, the Collaborative Attempt to Lower Lumpectomy Reoperation Rates (CALLER). The CALLER conference endorsed a "toolbox" of multiple processes of care for which there was evidence that they were associated with fewer reoperations. We present an update of the toolbox taking into consideration the latest advances in decreasing re excision rates. In this review, we performed a comprehensive review of the literature from 2015-2018 using search terms for each tool. The original ten tools were updated with the latest evidence from the literature and our strength of recommendation. We added an additional section looking at new tools and techniques that may provide more accurate intraoperative assessment of margins. The updates on the CALLER Toolbox for lumpectomy will help guide surgeons to various resources to aid in the removal of breast cancer, while being aware of cosmesis and decreasing re excision rates.