Performance and Practice Guideline for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer.

PURPOSE: The American Society of Breast Surgeons (ASBrS) sought to provide an evidence-based guideline on the use of neoadjuvant systemic therapy (NST) in the management of clinical stage II and III invasive breast cancer. METHODS: A comprehensive nonsystematic review was performed of selected peer-reviewed literature published since 2000. The Education Committee of the ASBrS convened to develop guideline recommendations. RESULTS: A performance and practice guideline was prepared to outline the baseline assessment and perioperative management of patients with clinical stage II-III breast cancer under consideration for NST. RECOMMENDATIONS: Preoperative or NST is emerging as an important initial strategy for the management of invasive breast cancer. From the surgeon's perspective, the primary goal of NST is to increase the resectability of locally advanced breast cancer, increase the feasibility of breast-conserving surgery and sentinel node biopsy, and decrease surgical morbidity. To ensure optimal patient selection and efficient patient care, the guideline recommends: (1) baseline breast and axillary imaging; (2) minimally invasive biopsies of breast and axillary lesions; (3) determination of tumor biomarkers; (4) systemic staging; (5) care coordination, including referrals to medical oncology, radiation oncology, plastic surgery, social work, and genetic counseling, if indicated; (6) initiation of NST; (7) post-NST breast and axillary imaging; and (8) decision for surgery based on extent of disease at presentation, patient choice, clinical response to NST, and genetic testing results, if performed.

131I hippuran quantitative scintillation camera studies in the evaluation and management of vesicoureteral reflux.

A study was made of 136 patients with vesicoureteral reflux with the conventional radiologic modalities of voiding cystourethrography and IVP. In addition, a 30-minute quantitative scintillation camera study was used. Comparison of these studies indicates that most periodic re-evaluations with IVP can be eliminated in favor of the scintillation study with its markedly reduced radiation dosage and lack of allergic type reactions. Unfortunately, as the quantitative scintillation camera study has been performed in these patients, it has been impossible to diagnose the presence of vesicoureteral reflux. Therefore, voiding cystourethrography or direct radionuclide cystography must be repeated at some time to determine if conservative management has been successful. The benefit of the routine use of the quantitative scintillation camera study in the early postoperative period seems to be strongly supported even by the small group of patients studied.