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Steinau an der Straße, Germany

Stoblen F.,Hyssensstift Kliniken Essen Mitte | Landt S.,Heinrich Heine University Dusseldorf | Ishaq R.,Toshiba Medical Systems GmbH | Stelkens-Gebhardt R.,Hyssensstift Kliniken Essen Mitte | And 5 more authors.
Anticancer Research | Year: 2011

Aim: To retrospectively evaluate the diagnostic value of high-frequency ultrasound for the detection of microcalcifications screening in BI-RADS 4a patients. Patients and Methods: A total of 52 women (mean age 60.5±65 years) classified as BI-RADS 4a with microcalcifications, but without associated masses after X-ray mammography (XRM) underwent ultrasound (US) examination (B-mode, ApliPure™, and MicroPure™ imaging). The results were assessed by two independent investigators and analyzed in relation to the B-classification. Written informed consent was obtained before enrolment. Results: The rate of US microcalcification detection was 98.1% (B-mode), 100% (ApliPure™) and 25% (MicroPure™), respectively. The microcalcification extent was significantly underestimated with all US modalities in comparison with XRM, but the difference was lower for ApliPure™ as compared to B-mode. ApliPure™ was also superior in terms of puncture feasibility, facilitating US-guided biopsy in 673% as compared to 48.1% (B-mode) and 15.4% (MicroPure™). Conclusion: In BI-RADS 4a patients, both high-frequency B-mode US and ApliPure™ imaging are highly sensitive for the detection of microcalcifications, whereas MicroPure™ ultrasound imaging is unsuitable. ApliPure™ imaging allowed US guided biopsy for 67.3% of lesions, providing a convenient and economical alternative to stereotactically guided biopsy.

Hockel K.,University of Tubingen | Maier G.,Klinikum Stuttgart | Rathgeb J.,Klinikum Stuttgart | Merkle M.,Sankt Gertrauden Hospital | Roser F.,University of Tubingen
European Spine Journal | Year: 2014

Purpose: Lateral mass (LM) fixation has become a standard in cervical spine instability treatment; however, maximal biomechanical stability combined with low morbidity remains a challenge. We evaluated our own patient cohort for bicortical screw placement and complication rates and investigated optimal screw trajectories with preoperative multiplanar computed tomography (CT) scans. Methods: Fifty-five patients were retrospectively evaluated after LM fixation at various subaxial cervical spine levels with a modified Magerl technique. Postoperative CTs and clinical records were used to determine LM anatomy, screw lengths, bicortical screw percentages, and complication rates. Additionally, 3D CT subaxial cervical spine data sets from 45 additional subjects with clinical indications for cervical spine imaging were evaluated. Subject LM geometries (thickness) were evaluated at different sagittal angulations (strict sagittal, 20°, 30° and the optimal angulation) for the optimal screw trajectories at the C3-C7 segments. Results: In total, 284 LM screws were placed, with a mean screw length of 16 mm and an 88 % bicortical bone purchase. Additionally, a 3.8 % malplacement rate was observed. LM thickness varied substantially between each subaxial cervical level and at each of the investigated angulations. The optimal angulation, at which LM thickness was maximal, increased continuously from C3 (14°) to C7 (38°). This increase permitted 8 % (C3) to 39 % (C7) gains in screw length compared with the strict sagittal plane assessments. Conclusions: The optimal LM trajectory varied for each subaxial segment. The knowledge of LM geometry allows for safe, long and even bicortical screw placements using preoperative sagittal CT imaging evaluations. © 2014 Springer-Verlag.

Eiermann W.,The Interdisciplinary Center | Rezai M.,Breast Center | Kummel S.,Senology Breast Care Center | Kuhn T.,Esslingen Hospital | And 12 more authors.
Annals of Oncology | Year: 2013

Background: We carried out a prospective clinical study to evaluate the impact of the Recurrence Score (RS) on treatment decisions in early breast cancer (EBC). Patients and methods: A total of 379 eligible women with estrogen receptor positive (ER+), HER2-negative EBC and 0-3 positive lymph nodes were enrolled. Treatment recommendations, patients' decisional conflict, physicians' confidence before and after knowledge of the RS and actual treatment data were recorded. Results: Of the 366 assessable patients 244 were node negative (N0) and 122 node positive (N+). Treatment recommendations changed in 33% of all patients (N0 30%, N+ 39%). In 38% of all patients (N0 39%, N+ 37%) with an initial recommendation for chemoendocrine therapy, the post-RS recommendation changed to endocrine therapy, in 25% (N0 22%, N+ 39%) with an initial recommendation for endocrine therapy only to combined chemoendocrine therapy, respectively. A patients' decisional conflict score improved by 6% (P = 0.028) and physicians' confidence increased in 45% (P < 0.001) of all cases. Overall, 33% (N0 29%, N+ 38%) of fewer patients actually received chemotherapy as compared with patients recommended chemotherapy pre-test. Using the test was cost-saving versus current clinical practice. Conclusion: RS-guided chemotherapy decision-making resulted in a substantial modification of adjuvant chemotherapy usage in node-negative and node-positive ER+ EBC.

Gerber B.,University of Rostock | Loibl S.,German Breast Group | Eidtmann H.,University of Kiel | Rezai M.,Luisen Hospital | And 17 more authors.
Annals of Oncology | Year: 2013

Background: We evaluated the pathological complete response (pCR) rate after neoadjuvant epirubicin, (E) cyclophosphamide (C) and docetaxel containing chemotherapy with and without the addition of bevacizumab in patients with triple-negative breast cancer (TNBC). Patients and methods: Patients with untreated cT1c-4d TNBC represented a stratified subset of the 1948 participants of the HER2-negative part of the GeparQuinto trial. Patients were randomized to receive four cycles EC (90/600 mg/m2; q3w) followed by four cycles docetaxel (100 mg/m2; q3w) each with or without bevacizumab (15 mg/kg; q3w) added to chemotherapy. Results: TNBC patients were randomized to chemotherapy without (n = 340) or with bevacizumab (n = 323). pCR (ypT0 ypN0, primary end point) rates were 27.9% without and 39.3% with bevacizumab (P = 0.003). According to other pCR definitions, the addition of bevacizumab increased the pCR rate from 30.9% to 41.8% (ypT0 ypN0/+; P = 0.004), 36.2% to 46.4% (ypT0/is ypN0/+; P = 0.009) and 32.9% to 43.3% (ypT0/is ypN0; P = 0.007). Bevacizumab treatment [OR 1.73, 95% confidence interval (CI) 1.23-2.42; P = 0.002], lower tumor stage (OR 2.38, 95% CI 1.24-4.54; P = 0.009) and grade 3 tumors (OR 1.68, 95% CI 1.14-2.48; P = 0.009) were confirmed as independent predictors of higher pCR in multivariate logistic regression analysis. Conclusions: The addition of bevacizumab to chemotherapy in TNBC significantly increases pCR rates. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Gerber B.,University of Rostock | Von Minckwitz G.,German Breast Group | Von Minckwitz G.,Goethe University Frankfurt | Eidtmann H.,University of Kiel | And 15 more authors.
Annals of Surgical Oncology | Year: 2014

Purpose. Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, has shown increased pathological complete response rates when added to neoadjuvant chemotherapy. In various cancer types, bevacizumab treatment was accompanied by an increased risk of bleedings and other surgical complications. We assessed associated surgical complications. Methods. In the GeparQuinto trial, 1,948 patients were randomized to receive four cycles epirubicin/cyclophosphamide (EC, 90/600 mg/m2 q3w) followed by four cycles docetaxel (D, 100 mg/m2 q3w) each with (ECB-DB) or without (EC-D) bevacizumab (B, 15 mg/kg q3w) concurrent with chemotherapy. Surgery had to be performed not earlier than 28 days after the last bevacizumab infusion, but within days 21 and 35 after the last chemotherapy. Results. In 743 (38.1 %) patients, a surgical complication (bleedings, hematomas, necrosis, wound infections, abscess) was documented prospectively. Baseline characteristics of the patients were well balanced between both arms. The breast-conserving surgery (BCS) rate (N = 502) was 69.1 % (EC-D) and 71.9 % (ECB-DB; p = 0.464). The first surgical procedure was performed at a median of 29 (EC-D) and 34 days (ECB-DB) after last chemotherapy with or without bevacizumab infusion (p < 0.001). Surgical complications were documented in 38 (10.9 %; EC-D) and 59 (15.0 %; ECB-DB) patients (p = 0.103). Surgical complications were significantly higher after ECD-DB only in patients treated with BCS (N = 53; p = 0.029) or in those requiring repeat surgery in order achieve clear margins (N = 23; p = 0.037) compared to the EC-D group. Conclusions. Addition of bevacizumab to neoadjuvant chemotherapy might be associated with an increased risk for surgical complications in patients treated with BCS or after repeated surgeries. © 2014 Society of Surgical Oncology.

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