Objectives Triple‐negative breast cancer (TNBC) is known to have unique molecular, clinical, and pathologic characteristics. The growth pattern of this cancer may also affect its appearance on sonography. Our study evaluated the sonographic features of TNBC according to the American College of Radiology Breast Imaging Reporting and Data System sonographic classification system and compared these features with those of non‐TNBC. Methods Data from 315 consecutive breast cancer cases were collected. The images were reevaluated by an examiner blinded to the patients' characteristics and histologic results according to the Breast Imaging Reporting and Data System. The sonographic features of TNBC (n = 33) and non‐TNBC (n = 282) were compared. Results Triple‐negative breast cancer was significantly correlated with a younger patient age (P = .002) and was associated with higher tumor grades (P < .001), more lymph node involvement (P = .014), and a trend toward a larger tumor size. With regard to sonographic features, the margin of TNBC was more frequently described as lobulated or microlobulated (75.8% versus 49.5% in non‐TNBC; P = .005). The echoic halo was observed significantly less often in TNBC than in non‐TNBC(39.4% versus 62.8%; P = .014). Cooper ligaments were displaced rather than disrupted in TNBC compared to non‐TNBC (P = .003). Regarding the posterior acoustic features, enhancement was observed significantly more often in TNBC (36.4% versus 13.0% in non‐TNBC; P = .031). Conclusions Triple‐negative breast cancer and non‐TNBC have different sonographic features. This finding can be explained by the pathologic profile of this breast cancer subtype. Some of the distinct sonographic criteria for TNBC are more likely to be associated with benign masses. Knowledge of the distinct sonographic features of TNBC would help the examiner avoid false‐negative classification of this tumor type.

HAL and MAL PDT do not leave any sustained damage in normal cervical tissue. This is of paramount importance as cervical insufficiency or stenosis may have implications on pregnancy and cervical cancer screening.

Introduction: Cervical intraepithelial neoplasia (CIN) represents the precursor of invasive cervical cancer and is associated with human papillomavirus infection (HPV) against which two vaccines have been approved in the last years. Standard treatments of high-grade CIN are conization procedures, which are associated with an increased risk of subsequent pregnancy complications like premature delivery and possible subsequent life-long disability. HPV vaccination has therefore the potential to decrease neonatal morbidity and mortality. This has not been taken into account in published cost-effectiveness models. Material and Methods: We calculated the possible reduction rate of conizations for different vaccination strategies for Germany. Using this rate, we computed the reduction of conization-associated preterm deliveries, life-long disability and neonatal death due to prematurity. The number of life-years saved (LYS) and gain in quality-adjusted life-years (QALYs) was estimated. The incremental costs per LYS / additional QALY were calculated. Results: The reduction of conization procedures was highest in scenario I (vaccination coverage 90% prior to HPV exposition) with about 50%. The costs per LYS or additional QALY were lowest in scenario I, II and III with 45,101 J or 43,505-47,855 J and rose up to 60,544 J or 58,401-64,240 J in scenario V (50% vaccinated prior to sexual activity + additional 20% catch-up at a mean age of 20 y). Conclusion: Regarding the HPV 16/18 vaccines as "vaccines against conization-related neonatal morbidity and mortality" alone, they already have the potential to be cost-effective. This effect adds up to reduction of cervical cancer cases and decreased costs of screening for CIN. Further studies on cost-effectiveness of HPV vaccination should take the significant amount of neonatal morbidity and mortality into account.

The learning curve for the total operation time and incision-delivery time reaches a flatter part after 10-15 caesarean sections. However, the learning process is highly individualised and difficult to predict, so that supervision and evaluation of the trainee by an experienced surgeon is important.

For Germany, PDT has the potential to be a cost-effective treatment for high-grade CIN compared to conisation procedure. Most important, the increased perinatal morbidity, perinatal mortality and associated costs after conisation procedures are significant and may be reduced by the implementation of PDT in CIN treatment.

Several studies evaluating the clinical effectiveness of endocrine therapy alone in breast cancer patients aged 70 years or older reported comparable survival rates to conventional surgical therapy, although the incidence of local recurrences was higher. Primary endocrine therapy is therefore only recommended as an alternative approach in elderly woman with estrogen receptor positive tumors who are deemed inoperable or who refuse surgery. We report our experience with aromatase inhibitors as primary endocrine therapy for estrogen receptor positive breast cancer in postmenopausal woman who are impaired by other diseases, refuse surgery or are of old age. Fifty-six patients with fifty-seven ER+ operable breast cancers who refused surgery, were judged ineligible for surgery because of comorbidity, or were of old age were treated with endocrine therapy using aromatase inhibitors only. Digital mammography and high-end breast ultrasound were used to assess tumor sizes. The mean age of the patients was 74 years (range 52-102 years). All patients suffered from breast cancer. The mean follow-up interval was 40 months (range 5-92 months). Seven patients (12%) achieved complete clinical remission, 31 (57%) partial response giving an overall objective response rate of 69%. In addition, seven (12%) patients showed stable disease, giving a clinical benefit rate (complete remission + partial response + stable disease rate) of 81%. Eleven patients (19%) progressed after an initial partial response or stable disease. Only one patient (2%) progressed on endocrine therapy within the first months. Eventually, 22 (39%) patients underwent surgery after informed consent to achieve better local tumor control. Primary endocrine therapy with aromatase inhibitors may offer an effective and safe alternative to surgery giving a high local control rate in postmenopausal women who refuse surgery, who are judged ineligible for surgery, or are of old age.

Einführung: Die Früherkennung des Zervixkarzinoms hat die rechtzeitige Entdeckung von hochgradigen Dysplasien des Gebärmutterhalses zum Ziel. Die Konisation als Standardtherapie der hochgradigen Zervixdysplasie ist heute in Deutschland eine der häufigsten bei Frauen im fertilen Alter durchgeführten, hoch effektiven Operationen. Allerdings können in nachfolgenden Schwangerschaften Komplikationen auftreten wie eine Zervixinsuffizienz mit vorzeitigem Blasensprung, Frühgeburtlichkeit und geringem Geburtsgewicht und eventuell lebenslanger fetaler Behinderung. Diese Therapiekosten müssen in die Gesamtbeurteilung der Konisation einbezogen werden. Methodik: Wir analysierten den gesamten Behandlungspfad nach Diagnosestellung einer therapiepflichtigen Zervixdysplasie hinsichtlich der Kosten. Mithilfe von Daten aus vorherigen Studien und Qualitätssicherungsprogrammen wurde insbesondere auch die entstehende maternofetale Morbidität analysiert. Ergebnisse: Die Gesamtkosten pro Konisation lagen bei 2178 €. Als größter Kostenfaktor stellt sich der Arbeitsausfall dar (1011 €). Für maternofetale Morbidität fielen 705 € an. Der geringste Kostenfaktor war die Konisation inklusive Nachsorge mit 462 €. Aufgrund der Konisation werden in Deutschland pro Jahr 71, 144 und 545 Kinder zu früh unterhalb der 28., 32. und 37. SSW geboren, statistisch werden 18, 24 und 65 Kinder unter einer schweren, mittelgradigen oder leichten Behinderung leiden. Schlussfolgerung: Die Kosten der Therapie maternofetaler Morbidität stellen 1 1 ⁄3 3 der Gesamtkosten der Konisation dar. Eine prospektive Verminderung der Anzahl an Konisationen sollte durch HPV-Impfung und strenge Indikationsstellung erfolgen, weiterhin ist eine Durchführung per Laser-oder Schlingenkonisation unter kolposkopischer Sicht anstatt Messerkonisation zu fordern.

We compared a dermoglandular rotation flap (DGR) in the upper inner, lower inner, and upper outer quadrant regarding similar aesthetic results, patient satisfaction, and comfort after breast-conserving therapy with standard segmentectomy (SE). Between 2003 and 2011, 69 patients were treated with breast-conserving surgery using DGR for cancers with high tumor-to-breast volume ratios or skin resection in the three above mentioned quadrants; 161 patients with tumors in the same quadrants were treated with SE. The outcome of the procedures was assessed at least 7 months after completed radiation therapy using a patient and breast surgeon questionnaire and the BCCT.core software. Symmetry, visibility of the scars, the position of the nipple-areola complex, and the appearance of the treated breast were each assessed on a scale from 1 to 4 by an expert panel and by the patients. Univariate and multivariate analysis were used to evaluate the relationship between patient-, tumor-, and treatment-dependent factors and patient satisfaction. 94.2% of the patients with rotation flaps and 83.5% of the patients with lumpectomy were very satisfied with the cosmetic appearance of their breast. Younger patient age was significantly associated with a lower degree of satisfaction. DGR provides good cosmetic results compared with SE and shows high patient satisfaction despite longer scarring and higher median resection volume.