A B S T R A C T PurposeSentinel lymph node biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. The aim of this study was to determine the long-term prevalence of lymphedema after SLN biopsy (SLNB) alone and after SLNB followed by axillary lymph node dissection (SLNB/ALND). Patients and MethodsAt median follow-up of 5 years, lymphedema was assessed in 936 women with clinically nodenegative breast cancer who underwent SLNB alone or SLNB/ALND. Standardized ipsilateral and contralateral measurements at baseline and follow-up were used to determine change in ipsilateral upper extremity circumference and to control for baseline asymmetry and weight change. Associations between lymphedema and potential risk factors were examined. ResultsOf the 936 women, 600 women (64%) underwent SLNB alone and 336 women (36%) underwent SLNB/ALND. Patients having SLNB alone were older than those having SLNB/ALND (56 v 52 years; P Ͻ .0001). Baseline body mass index (BMI) was similar in both groups. Arm circumference measurements documented lymphedema in 5% of SLNB alone patients, compared with 16% of SLNB/ALND patients (P Ͻ .0001). Risk factors associated with measured lymphedema were greater body weight (P Ͻ .0001), higher BMI (P Ͻ .0001), and infection (P Ͻ .0001) or injury (P ϭ .02) in the ipsilateral arm since surgery. ConclusionWhen compared with SLNB/ALND, SLNB alone results in a significantly lower rate of lymphedema 5 years postoperatively. However, even after SLNB alone, there remains a clinically relevant risk of lymphedema. Higher body weight, infection, and injury are significant risk factors for developing lymphedema.

These data suggest that increasing use of CPM is not associated with increased recognition of patients at high risk for CBC. Treatment factors, such as immediate reconstruction, preoperative MRI, and unsuccessful attempts at breast conservation, are associated with increased rates of CPM. Efforts to optimize breast conservation, minimize unnecessary tests, and improve patient education about the low risk of CBC may help to curb this trend.

Tumor presentation varies among molecular subtypes; this information may be useful in selecting local therapy. Neoadjuvant therapy and lymph nodes evaluation before surgery or neoadjuvant therapy are likely to be beneficial in HER-2-overexpressing tumors.

A B S T R A C T PurposeSentinel lymph node (SLN) biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. This study was undertaken to examine patient perceptions of lymphedema and use of precautionary behaviors several years after axillary surgery. Patients and MethodsNine hundred thirty-six women who underwent SLN biopsy (SLNB) alone or SLNB followed by axillary lymph node dissection (SLNB/ALND) between June 1, 1999, and May 30, 2003, were evaluated at a median of 5 years after surgery. Patient-perceived lymphedema and avoidant behaviors were assessed through interview and administered a validated instrument, and compared with arm measurements. ResultsCurrent arm swelling was reported in 3% of patients who received SLNB alone versus 27% of patients who received SLNB/ALND (P Ͻ .0001), as compared with 5% and 16%, respectively, with measured lymphedema. Only 41% of patients reporting arm swelling had measured lymphedema, and 5% of patients reporting no arm swelling had measured lymphedema. Risk factors associated with reported arm swelling were greater body weight (P Ͻ .0001), higher body mass index (P Ͻ .0001), infection (P Ͻ .0001), and injury (P ϭ .007) in the ipsilateral arm since surgery. Patients followed more precautions if they had measured or perceived lymphedema. ConclusionBody weight, infection, and injury are significant risk factors for perceiving lymphedema. There is significant discordance between the presence of measured and patient-perceived lymphedema. When compared to SLNB/ALND, SLNB-alone results in a significantly lower rate of patientperceived arm swelling 5 years postoperatively, and is perceived by fewer women than are measured to have it. J Clin

The presence of estrogen receptor (ER) in breast cancer is a prognostic indicator for both disease-free and overall survival. 16α-18F-fluoro-17β-estradiol (18F-FES) with PET is a noninvasive test for evaluation of ER expression and has been used for predicting response to endocrine therapy in patients with ER-positive metastatic breast cancer. The purpose of this study was to correlate 18F-FES PET and ER expression in patients with primary, operable breast cancer. Methods Forty-eight patients were prospectively enrolled in an institutional review board–approved protocol and signed an informed consent form. All patients had undergone 18F-FES PET preoperatively. Clinical characteristics, tumor characteristics, and treatment outcomes were recorded. Immunohistochemical analysis for ER and progesterone receptor (PgR) percentage expression (46 surgical, 2 core biopsy specimens) was performed. 18F-FES PET standardized uptake value (SUV) of the breast lesion was correlated with percentage immunohistochemistry ER and PgR expression. 18F-FES PET SUV was quantified, with a value of 1.5 or more considered positive, and ER and PgR was quantified, with 1% or more considered positive. Formalin-fixed paraffin-embedded tissue was available for 44 patients (42 surgical, 2 core biopsy specimens). We used a microarray platform, and estrogen-related gene expression data (ESR1, ESR2, and PGR) were compared with 18F-FES PET SUV (Spearman rank correlation). Tumor size, ductal histology, grade, HER2-neu overexpression, PgR expression, estradiol level, body mass index (BMI), and lean BMI were compared with 18F-FES PET uptake using univariate and multivariate analysis. Results Forty-eight patients completed our protocol, and 2 patients did not undergo surgery because bone metastases were identified preoperatively on 18F-FES PET. Eighty-three percent of our patients were stage I or II, with a median tumor size of 1.9 cm. Forty-one patients underwent a sentinel node biopsy. Twenty-one patients had nodal involvement. 18F-FES PET identified 5 patients with axillary nodal uptake (median SUV, 3.0; range, 1.7–6.9). These 5 patients had ER-positive breast cancer, and all had more than 4 positive nodes at the time of axillary node dissection. 18F-FES PET SUV was associated with immunohistochemistry ER expression. The sensitivity and specificity of the 18F-FES PET for the breast lesion were 0.85 and 0.75, respectively. Estrogen and progesterone gene expression (ESR1, ESR2, and PGR) was not associated with 18F-FES PET SUV (Spearman rank correlation). We found a significant correlation between 18F-FES PET SUV and tumor size (P = 0.0015) but not with ductal histology, grade, HER2-neu overexpression, PgR, estradiol, BMI, or lean BMI (logistic regression). ER expression (P < 0.001) and tumor size (P < 0.0001) were significant on multivariate regression analysis. Conclusion 18F-FES PET SUV correlated with ER immunohistochemistry expression but not gene expression in our patients with early breast cancer. We found that size of primary tumor was signi...

In our experience, 29% of breast incidentalomas (7 of 24) with persistent imaging findings were malignant. Further evaluation of these lesions should be based on overall clinical status. In patients where results would not change overall management, biopsy may not be warranted.

Although clinical psychology has made strides in developing prevention and intervention strategies to reduce youth violence, there has been little attention to skills-oriented preprofessional training to prepare graduate students for practice roles in this emerging area of public health concern. This article describes a practicum training experience that prepares doctoral-level clinical psychology trainees to serve as youth violence prevention service providers, trainers, and consultants.

INTRODUCTION:Rates of CPM are reported to be increasing, yet factors driving this trend are unclear. We performed this analysis to determine if increasing rates of CPM are being driven by increased recognition of risk factors for contralateral breast cancer (CBC) or by treatment factors related to the index lesion.METHODS:From 1997-2005, 2967 patients with Stage 0-III primary unilateral breast cancer underwent mastectomy at MSKCC and were entered into a prospectively maintained database. Demographic, tumor and treatment factors were abstracted and comparisons made between patients who did and did not undergo CPM within one year of treatment for their index cancer. Generalized estimating equations were used to fit logistic regression models to identify independent predictors of CPM.RESULTS:The overall rate of CPM was 13.8%(n=408), increasing from 6.7% in 1997 to 24.4% in 2005 (p&lt;0.0001). The median age of CPM pts was 44.9 vs 53.2 in the non-CPM group (p&lt;.001) and only 7% of CPM pts were non-white compared to 25% of non-CPM pts (p&lt;.001). Although 69% of CPM pts had a family history (FH) of breast cancer (vs 40% non-CPM; p&lt;.001) only 8% had 2 or more first degree relatives affected. Genetic testing was performed in 29% of CPM pts; of those 37 (31%) were positive. The use of MRI increased from 1.3% to 36.3%of cases over the study period. MRI at diagnosis (43% vs 16%) and MRI generated biopsy in the contralateral or bilateral breasts (29% vs 4%) were strongly associated with CPM (p&lt;.0001). Prior attempts at breast conservation (BCT) (28% vs 16%; p&lt;.001) were more common in the CPM group, but number of attempts did not differ between groups. Patients undergoing CPM were more likely to have DCIS versus an invasive histology (p&lt;0.0001), and of those with invasive disease, CPM patients had smaller tumors (1.2cm vs. 1.8cm, p&lt;0.0001) and were more likely to be node negative (53% vs 43%, p&lt;0.0001). ER, PR, and HER2 status were not associated with CPM. CPM rates among surgeons ranged from 9.8% to 26%. Multivariate analysis of predictors of CPM for 2387 patients with complete data is shown in the Table.VariableORp95%CIWhite race3.6&lt;0.00012.4-5.4Age&lt;502.3&lt;0.00011.8-3.1FH breast cancer2.9&lt;0.00012.3-3.7MRI at Dx2.2&lt;0.00011.7-2.8BCT attempted1.60.000081.2-2.1Reconstruction3.2&lt;0.00012.3-4.5DCIS histology1.40.021.1-1.9*adjusted for surgeonCONCLUSIONS: Factors associated with clinical management of the index cancer such as preoperative MRI with the potential for additional biopsy, failed attempt at BCT, and breast reconstruction were strongly associated with CPM. Age and FH were also independent predictors; however the FH profiles of CPM pts in this series do not support increased recognition of mutation carriers and truly high risk FH as a major cause of increasing rates of CPM. The lack of association with ER status, which results in treatment that decreases the risk of CBC, provides additional support that patients may be choosing CPM for reasons other than future risk. These data suggest that the need for additional procedures during management of the index cancer may be contributing to the increasing use of CPM among a relatively moderate risk patient population. Efforts to optimize BCT and minimize unnecessary tests may help to curb this trend. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 38.