Kimberly Stone, MD

All Publications

• Comparison of Two Wireless Localization Technologies for Removal of Non-palpable Breast Lesions: SCOUTRadar Reflector and PintuitionMagnetic Seed. Annals of surgical oncology Chinn, J., Earley, M., Dashevsky, B. Z., Stone, K., Thompson, C. N., Bao, J. 2025

  Abstract

  BACKGROUND: The SCOUT radar reflector (SCOUT) is a common wireless technology used for removal of non-palpable breast lesions. The Pintuition magnetic seed (Pintuition) utilizes a magnetic marker encapsulated in nickel-free titanium. This is the first study comparing surgical outcomes of SCOUT and Pintuition.METHODS: A retrospective, single-institution review was conducted evaluating lumpectomies and excisional biopsies of non-palpable breast lesions performed between May 2022 and July 2024 utilizing wireless localization for intraoperative guidance. The SCOUT was the only wireless option at our institution prior to June 2023, at which time the Pintuition seed became available. Patients with multiple localizations or oncoplastic reconstruction were excluded. Patient characteristics, procedure type, lesion characteristics, positive margin, and re-excision rates were compared using the Chi-square or Fisher's exact tests for categorical variables and Wilcoxon rank-sum test for continuous variables. Generalized linear models were used to compare surgery length and specimen volume.RESULTS: Of 90 lesions identified, 45 were localized by SCOUT and 45 by Pintuition. Age, body mass index (BMI), surgery type, neoadjuvant therapy, total specimen volume, pathologic cancer size, positive margin, and margin re-excision rates were not found to differ by device. All Pintuition seeds were removed on index operation, whereas one SCOUT was not. Surgery length was significantly shorter for Pintuition cases compared with SCOUT (median 37 min vs. 50 min; p=0.006). One patient in each group required margin re-excision.CONCLUSIONS: Operative time was significantly shorter for Pintuition cases. Pintuition represents a reliable and effective wireless localization technique. Considerations need to be given to nuanced features of each device.

  View details for DOI 10.1245/s10434-025-18354-x

  View details for PubMedID 40946252

• Impact of timing and breastfeeding on postpartum breast cancer diagnostic patterns and outcomes. Breast cancer research and treatment Klebaner, D., Park, N., Stone, K., Riaz, F., Crowe, S., Telli, M., Marquez, C., Horst, K. 2025

  Abstract

  Postpartum breast cancers (PPBC) have a worse prognosis than other breast cancers, but the impact of timing postpartum (PP) and concurrent breastfeeding (BF) on diagnostic patterns and outcomes remains unclear.We analyzed 161 PPBC patients diagnosed from 2002 to 2014, hypothesizing that diagnosis < 2 years PP (vs 2-5 years) and concurrent BF (vs not BF) at diagnosis would be associated with delayed diagnosis. We compared 2-year PP patients (N = 60) and 2-5 year PP patients (N = 101), and subsequently, patients who were (n = 36) and were not (n = 24) BF at diagnosis among the 2-year PP group with respect to clinicopathologic characteristics, breastfeeding details, diagnostic patterns, and disease outcomes. Differences were evaluated using chi-square and Mann-Whitney tests. Kaplan-Meier analysis assessed overall survival (OS) and distant disease-free survival (DDFS).Median follow-up was 54 months. Patients in the 2-year PP group were more likely to be BF at diagnosis (60% vs 7%, p < 0.001), and have their symptoms attributed to lactational change (37 vs 9%, p < 0.001). They were also diagnosed at a higher stage (43 vs 24% Stage III/IV, p = 0.01), had worse 5-year OS (79% vs 97%, p < 0.001), and DDFS (74% vs 93%, p = 0.003) compared to 2-5 year PP patients. Among 2-year PP patients, patients BF at diagnosis were more likely to be diagnosed with mastitis preceding diagnosis (31% vs 4%, p = 0.03), more often had their symptoms attributed to lactational change (58% vs 4%), trended toward higher stage at diagnosis (53 vs 29% Stage III/IV, p = 0.1), had significantly worse 5-year DDFS (62% vs 91%, p = 0.032), and trended toward worse OS (74% vs 86%, p = 0.08) compared to those not BF.Our findings suggest that early PPBC and BF at diagnosis are associated with diagnostic delay and higher stage at diagnosis, which may have implications for prognosis.

  View details for DOI 10.1007/s10549-025-07796-2

  View details for PubMedID 40739382

• Impact of timing of diagnosis and breastfeeding on postpartum breast cancer outcomes. Klebaner, D., Park, N., Marquez, C., Stone, K., Crowe, S., Riaz, F., Telli, M. L., Horst, K. C. LIPPINCOTT WILLIAMS & WILKINS. 2025: e12537

  View details for DOI 10.1200/JCO.2025.43.16_suppl.e12537

  View details for Web of Science ID 001509229800001

• Frailty Analysis and Outcomes of Breast Cancer Surgery in Elderly Patients Aged 85 and Older Foulad, D., Wapnir, I., Xu, A., Stone, K., Dirbas, F., Karin, M., Najafzadeh, P., Allison, K., Tsai, J. SPRINGER. 2023: S331-S332

  View details for Web of Science ID 000999257500037

• Intraoperative Pegulicianine Fluorescence Guidance for Tumor Detection During Lumpectomy Surgery for Stage 0-III Breast Cancer Smith, B. L., Hunt, K. K., Carr, D., Blumencranz, P., Hwang, E., Gadd, M. A., Stone, K., Dyess, D. L., Dodge, D., Valente, S., Dekhne, N., Clark, P., Lee, M., Samiian, L., Lesnikoski, B., Clark, L., Smith, K., Chang, M., Schlossberg, B., Ferrer, J., Wapnir, I. SPRINGER. 2023: S297-S298

  View details for Web of Science ID 000999257500013

• Nipple-areola-complex preservation and obesity-Successful in stages. Microsurgery Daly, L., Tsai, J., Stone, K., Wapnir, I., Karin, M., Wan, D., Momeni, A. 2023

  Abstract

  The superiority of nipple-sparing mastectomy (NSM) on breast aesthetics and patient-reported outcomes has previously been demonstrated. Despite 42.4% of adults in the United States being considered obese, obesity has been considered a contraindication to NSM due to concerns for nipple areolar complex (NAC) malposition or ischemic complications. This report investigates the feasibility and safety of a staged surgical approach to NSM with immediate microsurgical breast reconstruction in the high-risk obese population.Only patients with a body mass index (BMI) of >30 kg/m2 who underwent bilateral mastopexy or breast reduction for correction of ptosis or macromastia (stage 1), respectively, followed by bilateral prophylactic NSM with immediate microsurgical breast reconstruction with free abdominal flaps (stage 2) were included in the analysis. Patient demographics and surgical outcomes were analyzed.Fifteen patients with high-risk genetic mutations for breast cancer with a mean age and BMI of 41.3 years and 35.0 kg/m2 , respectively, underwent bilateral staged NSM with immediate microsurgical breast reconstruction (30 breast reconstructions). At a mean follow-up of 15.7 months, complications were encountered following stage 2 only and included mastectomy skin necrosis (5 breasts [16.7%]), NAC necrosis (2 breasts [6.7%]), and abdominal seroma (1 patient [6.7%]) all of which were considered minor and neither required surgical intervention nor admission.Implementation of a staged approach permits NAC preservation in obese patients who present for prophylactic mastectomy and immediate microsurgical reconstruction.

  View details for DOI 10.1002/micr.31043

  View details for PubMedID 37013250

• Intraoperative Fluorescence Guidance for Breast Cancer Lumpectomy Surgery New England Journal of Medicine Evidence Smith, B., 2023

  View details for DOI 10.1056/EVIDoa2200333

• Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for Lymphedema Prevention after Axillary Lymph Node Dissection-A Single Institution Experience and Feasibility of Technique. Journal of clinical medicine Lipman, K., Luan, A., Stone, K., Wapnir, I., Karin, M., Nguyen, D. 2021; 11 (1)

  Abstract

  While surgical options exist to treat lymphedema after axillary lymph node dissection (ALND), the lymphatic microsurgical preventive healing approach (LYMPHA) has been introduced as a preventive measure performed during the primary surgery, thus avoiding the morbidity associated with lymphedema. Here, we highlight details of our operative technique and review postoperative outcomes. For our patients, limb measurements and body composition analyses were performed pre- and postoperatively. Intraoperatively, axillary reverse lymphatic mapping was performed with indocyanine green (ICG) and lymphazurin. SPY-PHI imaging was used to visualize the ICG uptake into axillary lymphatics. Cut lymphatics from excised nodes were preserved for lymphaticovenous anastomosis (LVA). At the completion of the microanastomosis, ICG was visualized draining from the lymphatic through the recipient vein. A retrospective review identified nineteen patients who underwent complete or partial mastectomy with ALND and subsequent LYMPHA over 19 months. The number of LVAs performed per patient ranged between 1-4 per axilla. The operating time ranged from 32-95 min. There were no surgical complications, and thus far one patient developed mild lymphedema with an average follow up of 10 months. At the clinic follow up, ICG and SPY angiography were used to confirm intact lymphatic conduits with an uptake of ICG across the axilla. This study supports LYMPHA as a feasible and effective method for lymphedema prevention.

  View details for DOI 10.3390/jcm11010092

  View details for PubMedID 35011833

• A randomized phase II study comparing surgical excision versus NeOadjuvant Radiotherapy followed by delayed surgical excision of Ductal carcinoma In Situ (NORDIS) Wapnir, I., DeMartini, W., Allison, K., Stone, K., Dirbas, F., Marquez, C., Ikeda, D., Pal, S., Tsai, J., Yang, R., West, R., McMillan, A., Telli, M., Horst, K. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7445.SABCS19-OT3-09-04

  View details for Web of Science ID 000527012500151

• The Biology Behind the American College of Surgeons Oncology Group Z0011 Trial JAMA SURGERY Stone, K., Wheeler, A. J. 2015; 150 (12): 1148–49

  View details for PubMedID 26332793

• A Review of Anatomy, Physiology, and Benign Pathology of the Nipple ANNALS OF SURGICAL ONCOLOGY Stone, K., Wheeler, A. 2015; 22 (10): 3236-3240

  Abstract

  The nipple and areola are pigmented areas of modified skin that connect with the underlying gland of the breast via ducts. The fairly common congenital anomalies of the nipple include inversion, clefts, and supernumerary nipples. The anatomy of the nipple areolar complex is discussed as a foundation to review anatomical variants, and the physiologic development of the nipple, including changes in puberty and pregnancy, as well as the basis of normal physiologic discharge, are addressed. Skin conditions affecting the nipple include eczema, which, while similar to eczema occurring elsewhere on the body, poses unique aspects in terms of diagnosis and treatment. This article concludes with discussion on the benign abnormalities that develop within the nipple, including intraductal papilloma and nipple adenoma.

  View details for DOI 10.1245/s10434-015-4760-4

  View details for Web of Science ID 000360303800014

  View details for PubMedID 26242366