Research Spotlight

Schiattarella, G. G., A. Sannino, G. Esposito and C. Perrino (2019). “Diagnostics and therapeutic implications of gut microbiota alterations in cardiometabolic diseases.” Trends Cardiovasc Med 29(3): 141-147.

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Alterations in gut microbiota composition and its metabolic activity are emerging as one of the most powerful determinants of cardiovascular disease. Although our knowledge of the precise molecular mechanisms by which gut microbiota influences cardiometabolic homeostasis is still limited, a growing body of knowledge has recently been uncovered about the potential modulation of microbiome for cardiovascular diagnostic and therapeutic aspects. The multitude of interactions between the microorganisms inhabiting the digestive tract and the host has been recognized crucial in the development and progression of atherosclerosis, obesity, diabetes and hypertension. Here, we summarize the role of gut microbiota in host physiology as well as in the pathophysiology of the most common cardio-metabolic disorders, discussing the potential therapeutic opportunities offered by interventions aimed at modifying microbiome composition and activity.

Raj, S. D., M. Shurafa, Z. Shah, K. M. Raj, M. D. C. Fishman and V. M. Dialani (2019). “Primary and Secondary Breast Lymphoma: Clinical, Pathologic, and Multimodality Imaging Review.” Radiographics Mar 29: 180097. [Epub ahead of print].

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Breast lymphoma is a rare hematologic neoplasm that originates in the breast lymphoid tissue and includes primary breast lymphoma (PBL) and secondary breast lymphoma (SBL). PBL involves the breast lymphoid tissue in the absence of previously identified extramammary lymphoma and widespread disease. SBL is the most common metastasis to the breast, accounting for 17% of metastatic disease to the breast. PBL and SBL usually demonstrate imaging phenotypes that overlap with those of primary breast carcinoma, which makes a prospective diagnosis of breast lymphoma challenging. These nonspecific imaging features include an iso- to hyperdense oval mass or masses at mammography, a hypoechoic or mixed-echogenicity hypervascular mass at US, an enhancing mass with type II kinetics at MRI, and high fluorine 18-fluorodeoxyglucose avidity at PET. In cases of suspected lymphoma, reviewing the clinical history, using appropriate biopsy techniques, and evaluating for multiplicity, bilaterality, and distant disease are critical for diagnosis and management. A patient with PBL generally has an earlier clinical presentation with a palpable abnormality and a solitary imaging finding. In contrast, multiple masses in an older patient and an occult clinical presentation favor an SBL diagnosis.

Raj, S. D., M. M. Agrons, P. Woodtichartpreecha, M. J. Kalambo, B. E. Dogan, H. Le-Petross and G. J. Whitman (2019). “MRI-guided needle localization: Indications, tips, tricks, and review of the literature.” Breast J Mar 28. [Epub ahead of print].

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We describe the history of, indications for, and techniques involved in MRI-guided needle localization (MRI-NL). MRI-NL continues to be a safe, effective method of sampling lesions that are only detected with MRI, particularly for anatomically challenging lesions such as those near the chest wall, the nipple, the skin, and/or in close proximity to implants.

Plichta, J. K., M. L. Sebastian, L. A. Smith, C. S. Menendez, A. T. Johnson, S. M. Bays, D. M. Euhus, E. J. Clifford, M. Jalali, S. H. Kurtzman, W. A. Taylor and K. S. Hughes (2019). “Germline Genetic Testing: What the Breast Surgeon Needs to Know.” Ann Surg Oncol Apr 2. [Epub ahead of print].

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PURPOSE: The American Society of Breast Surgeons (ASBrS) sought to provide educational guidelines for breast surgeons on how to incorporate genetic information and genomics into their practice. METHODS: A comprehensive nonsystematic review was performed of selected peer-reviewed literature. The Genetics Working Group of the ASBrS convened to develop guideline recommendations. RESULTS: Clinical and educational guidelines were prepared to outline the essential knowledge for breast surgeons to perform germline genetic testing and to incorporate the findings into their practice, which have been approved by the ASBrS Board of Directors. RECOMMENDATIONS: Thousands of women in the USA would potentially benefit from genetic testing for BRCA1, BRCA2, and other breast cancer genes that markedly increase their risk of developing breast cancer. As genetic testing is now becoming more widely available, women should be made aware of these tests and consider testing. Breast surgeons are well positioned to help facilitate this process. The areas where surgeons need to be knowledgeable include: (1) identification of patients for initial breast cancer-related genetic testing, (2) identification of patients who tested negative in the past but now need updated testing, (3) initial cancer genetic testing, (4) retesting of patients who need their genetic testing updated, (5) cancer genetic test interpretation, posttest counseling and management, (6) management of variants of uncertain significance, (7) cascade genetic testing, (8) interpretation of genetic tests other than clinical cancer panels and the counseling and management required, and (9) interpretation of somatic genetic tests and the counseling and management required.

Peters, W. R. (2019). “What Every Colorectal Surgeon Should Know About the New American Cancer Society’s Colorectal Cancer Screening Guidelines.” Dis Colon Rectum 62(4): 397-398.

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The American Cancer Society recently published an updated guideline for colorectal cancer (CRC) screening of average-risk adults, calling for screening to begin at 45 years of age. The recommendation was widely publicized in the media because it is the first practice guideline to recommend that screening begin at age 45 years instead of age 50 years. This news coverage has undoubtedly generated questions from patients about the implications of this recommendation for their own personal plan of care. It is important that colorectal surgeons, as recognized experts in the prevention, detection, and treatment of CRC, understand the American Cancer Society recommendations in the context of our multipayer healthcare system . . . Because the recent recommendation was developed by the American Cancer Society, rather than the US Preventive Services Task Force (USPSTF), Centers for Medicare & Medicaid Services and private health plans have no legal obligation to provide coverage for screening average-risk patients aged <50 years. Unless the recommendation of the USPSTF is revised, the decision to cover screening for patients between 45 and 50 years will be left to individual health plans. This determination will require a financial analysis of the cost of such screening and an adjustment to premiums to cover that cost. Because premiums are set annually, there may be a delay of 1 to 2 years before any health plan modifies their current coverage standards for screening. It is also quite possible that a health plan might choose to provide coverage for only some of the recommended methods for patients aged <50 years. For example, a plan might agree to pay for stool-based detection methods but not for structural exams. (Excerpt from text, p. 397-398; no abstract available.)