Rachel L. Yang, MD, FACS, NABBLM-C, IBCLC

All Publications

• Breastfeeding Counseling Practices Among Plastic Surgeons: Results From a National Survey. Plastic and reconstructive surgery. Global open Bryan, J., Ockerman, K., Yang, R., Cox, E., Safeek, R., Curtin, C., Virk, S. S. 2025; 13 (4): e6691

  Abstract

  Breastfeeding has well-established benefits for maternal and infant health. Difficulty with breastfeeding is a possible complication after breast surgery and can have detrimental maternal psychological consequences. Although lactation outcomes after breast surgery have been reported, plastic surgeons' preoperative counseling practices regarding breastfeeding after surgery have not yet been studied.From November 2021 to January 2022, a 25-question anonymous survey on breastfeeding counseling practices, personal breastfeeding experiences, demographics, surgical training, and length of practice was administered to 6000 members of the American Society of Plastic Surgeons.A total of 146 respondents were included, and 90.7% of respondents believe that breast surgery can affect breastfeeding. Although 96.6% of respondents routinely discuss possible postoperative challenges with breastfeeding, 39.3% differentiate between inclusive and exclusive breastfeeding, 22.2% discuss potential emotional consequences, and only 12.8% discuss the need for galactagogues or labor-intensive ancillary activities. Significantly more respondents who had been in practice for less than 15 years believed that breast surgery can affect breastfeeding and reported counseling on breastfeeding impairment risk before transgender top surgery, compared with those who had been out of training for more than 15 years (96% versus 84%, P = 0.05; 72% versus 54%, P = 0.05).Most plastic surgeons believe breast surgery can affect lactation and counsel patients as such. However, the potential deleterious mental health consequences of challenged breastfeeding after breast surgery seem undercounseled. Our findings highlight a potential need for increased education and improved preoperative breastfeeding counseling protocols for plastic surgeons.

  View details for DOI 10.1097/GOX.0000000000006691

  View details for PubMedID 40230467

  View details for PubMedCentralID PMC11995991

• ASO Visual Abstract: Changes in Surgical Management of the Axilla Over 11 Years-Report on Over 1500 Breast Cancer Patients Treated with Neoadjuvant Chemotherapy on the Prospective I-SPY2 Trial. Annals of surgical oncology Boughey, J. C., Yu, H., Dugan, C. L., Piltin, M. A., Postlewait, L., Son, J. D., Edmiston, K. K., Godellas, C., Lee, M. C., Carr, M. J., Tonneson, J. E., Crown, A., Lancaster, R. B., Woriax, H. E., Ewing, C. A., Chau, H. S., Patterson, A. K., Wong, J. M., Alvarado, M. D., Yang, R. L., Chan, T. W., Sheade, J. B., Ahrendt, G. M., Larson, K. E., Switalla, K., Tuttle, T. M., Tchou, J. C., Rao, R., Tamirisa, N., Singh, P., Gould, R. E., Terando, A., Sauder, C., Hewitt, K., Chiba, A., Esserman, L. J., Mukhtar, R. 2023

  View details for DOI 10.1245/s10434-023-14017-x

  View details for PubMedID 37537482

• Changes in Surgical Management of the Axilla Over 11 Years - Report on More Than 1500 Breast Cancer Patients Treated with Neoadjuvant Chemotherapy on the Prospective I-SPY2 Trial. Annals of surgical oncology Boughey, J. C., Yu, H., Dugan, C. L., Piltin, M. A., Postlewait, L., Son, J. D., Edmiston, K. K., Godellas, C. V., Lee, M. C., Carr, M. J., Tonneson, J. E., Crown, A., Lancaster, R. B., Woriax, H. E., Ewing, C. A., Chau, H. S., Patterson, A. K., Wong, J. M., Alvarado, M. D., Yang, R. L., Chan, T. W., Sheade, J. B., Ahrendt, G. M., Larson, K. E., Switalla, K., Tuttle, T. M., Tchou, J. C., Rao, R., Tamirisa, N., Singh, P., Gould, R. E., Terando, A., Sauder, C., Hewitt, K., Chiba, A., Esserman, L. J., Mukhtar, R. A. 2023

  Abstract

  BACKGROUND: Axillary surgery after neoadjuvant chemotherapy (NAC) is becoming less extensive. We evaluated the evolution of axillary surgery after NAC on the multi-institutional I-SPY2 prospective trial.METHODS: We examined annual rates of sentinel lymph node (SLN) surgery with resection of clipped node, if present), axillary lymph node dissection (ALND), and SLN and ALND in patients enrolled in I-SPY2 from January 1, 2011 to December 31, 2021 by clinical N status at diagnosis and pathologic N status at surgery. Cochran-Armitage trend tests were calculated to evaluate patterns over time.RESULTS: Of 1578 patients, 973 patients (61.7%) had SLN-only, 136 (8.6%) had SLN and ALND, and 469 (29.7%) had ALND-only. In the cN0 group, ALND-only decreased from 20% in 2011 to 6.25% in 2021 (p = 0.0078) and SLN-only increased from 70.0% to 87.5% (p = 0.0020). This was even more striking in patients with clinically node-positive (cN+) disease at diagnosis, where ALND-only decreased from 70.7% to 29.4% (p < 0.0001) and SLN-only significantly increased from 14.6% to 56.5% (p < 0.0001). This change was significant across subtypes (HR-/HER2-, HR+/HER2-, and HER2+). Among pathologically node-positive (pN+) patients after NAC (n = 525) ALND-only decreased from 69.0% to 39.2% (p < 0.0001) and SLN-only increased from 6.9% to 39.2% (p < 0.0001).CONCLUSIONS: Use of ALND after NAC has significantly decreased over the past decade. This is most pronounced in cN+ disease at diagnosis with an increase in the use of SLN surgery after NAC. Additionally, in pN+ disease after NAC, there has been a decrease in use of completion ALND, a practice pattern change that precedes results from clinical trials.

  View details for DOI 10.1245/s10434-023-13759-y

  View details for PubMedID 37380911

• Developing an Inpatient Relationship Centered Communication Curriculum (I-RCCC) rounding framework for surgical teams. BMC medical education Nassar, A. K., Weimer-Elder, B., Yang, R., Kline, M., Dang, B. K., Spain, D. A., Knowlton, L. M., Valdez, A. B., Korndorffer, J. R., Johnson, T. 2023; 23 (1): 137

  Abstract

  Morning rounds by an acute care surgery (ACS) service at a level one trauma center are uniquely demanding, given the fast pace, high acuity, and increased patient volume. These demands notwithstanding, communication remains integral to the success of surgical teams. Yet there are limited published curricula that address trauma inpatient communication needs. Observations at our institution confirmed that the surgical team lacked a shared mental model for communication. We hypothesized that creating a relationship-centered rounding conceptual framework model would enhance the provider-patient experience.A mixed-methods approach was used for this study. A multi-pronged needs assessment was conducted. Provider communion items for Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to measure patients' expressed needs. Faculty with experience in relationship-centered communication observed morning rounds and documented demonstrated behaviors. A five-hour workshop was designed based on the identified needs. A pre-and post-course Assessment and course evaluation were conducted. Provider-related patient satisfaction items were measured six months before the course and six months after the workshop.Needs assessment revealed a lack of a shared communication framework and a lack of leadership skills for senior trauma residents. Barriers included: time constraints, patient load, and interruptions during rounds. The curriculum was very well received. The self-reflected behaviors that demonstrated the most dramatic change between the pre and post-workshop surveys were: I listened without interrupting; I spoke clearly and at a moderate pace; I repeated key points; and I checked that the patient understood. All these changed from being performed by 50% of respondents "about half of the time" to 100% of them "always". Press Ganey top box likelihood to recommend (LTR) and provider-related top box items showed a trend towards improvement after implementing the training with a percentage difference of up to 20%.The Inpatient Relationship Centered Communication Curriculum (I-RCCC) targeting senior residents and Nurse Practitioners (NP) was feasible, practical, and well-received by participants. There was a trend of an increase in LTRs and provider-specific patient satisfaction items. This curriculum will be refined based on the study results and potentially scalable to other surgical specialties.

  View details for DOI 10.1186/s12909-023-04105-7

  View details for PubMedID 36859253

• 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

• Developing an Inpatient Relationship-Centered Communication Curriculum for Surgical Teams: Pilot Study Nassar, A., Weimer-Elder, B., Kline, M., Minthorn, C., Staudenmayer, K. L., Yang, R., Spain, D. A., Maggio, P., Korndorffer, J. R., Johnson, T. ELSEVIER SCIENCE INC. 2019: E48

  View details for Web of Science ID 000492749600102

• Female trainees believe that having children will negatively impact their careers: results of a quantitative survey of trainees at an academic medical center. BMC medical education Kin, C., Yang, R., Desai, P., Mueller, C., Girod, S. 2018; 18 (1): 260

  Abstract

  BACKGROUND: Medical training occurs during peak childbearing years. However, the intense workload, long work hours, and limited financial compensation are potential barriers to having children during this time. Here, we aimed to identify gender-based differences in beliefs and experiences of having children during graduate medical education. We hypothesized that both genders face significant challenges, but women are more likely to experience stressors related to work-family conflicts.METHODS: We administered an anonymous web-based survey to all trainees at an academic medical center. Primary outcomes were gender differences in beliefs and experiences of having children during training. Multivariate logistic regression was performed using independent variables of gender, specialty type (surgical vs. medical), and parental status.RESULTS: In total, 56% of trainees responded (60% women, 40% men; n=435). Women were more often concerned about the negative impact of having children and taking maternity leave on their professional reputation and career. The majority of women expressed concern about the potential negative impact of the physical demands of their jobs on pregnancy. Among parents, women were more likely than men to be the primary caregivers on weeknights and require weekday childcare from a non-parent.CONCLUSIONS: Women face greater work-related conflicts in their beliefs and experiences of having a family during graduate medical education. Trainees should be aware of these potential challenges when making life and career decisions. We recommend that institutions employ solutions to accommodate the needs and wellbeing of trainees with families while optimizing training and workload equity for all trainees.

  View details for PubMedID 30424762

• Female trainees believe that having children will negatively impact their careers: results of a quantitative survey of trainees at an academic medical center BMC MEDICAL EDUCATION Kin, C., Yang, R., Desai, P., Mueller, C., Girod, S. 2018; 18

  View details for DOI 10.1186/s12909-018-1373-1

  View details for Web of Science ID 000450266500001

• Bridging gaps in breast cancer care: A pilot forum for mental health professionals Yang, R., Rabinowitz, B., Frank, M., Schapira, L., Wapnir, I. AMER ASSOC CANCER RESEARCH. 2018

  View details for Web of Science ID 000425489402012

• Hispanic Breast Cancer Patients Travel Further for Equitable Surgical Care at a Comprehensive Cancer Center. Health equity Yang, R. L., Wapnir, I. 2018; 2 (1): 109–16

  Abstract

  Purpose: Disparities in surgical breast cancer care have been documented for racial and ethnic minorities. On average, these minorities are less likely to utilize National Cancer Institute (NCI)-designated cancer centers and travel shorter distances to receive care. With the growing population of Hispanic patients in California, we analyzed the travel distance and surgical care of Hispanic and non-Hispanic patients at our large referral cancer center. Methods: Patients included were those who initiated treatment for a new diagnosis of ductal carcinoma in situ or invasive breast cancer at our NCI-designated cancer center during the period 2010-2014. Ethnicity was dichotomized as Hispanic and non-Hispanic. Google Maps were used to determine the distance from patient zip code to our institution, classified as 0-10, 10-30, 30-60, and >60 miles. Results: A total of 1765 non-Hispanic and 173 Hispanic patients were identified. Clinical stage by tumor size and nodal status were comparable between the two groups. Hispanic patients were younger (p<0.001) and more had Medicaid insurance (p<0.001). Hispanic patients traveled further when compared with non-Hispanics (p<0.001). In non-Hispanics and Hispanics, rates of breast conservation were 57.4% and 52.3% (p=0.30), unilateral mastectomy 34.2% and 36.2% (p=0.44), bilateral mastectomy 8.4% and 11.5% (p=0.24), and immediate postmastectomy reconstruction 42.6% and 50.6% (p=0.34), respectively. Hispanic ethnicity was not associated with different odds of receiving breast conservation (odds ratio [OR] 1.01, confidence interval [CI] 0.73-1.40), unilateral mastectomy (OR 1.05, CI 0.75-1.44), bilateral mastectomy (OR 1.37, CI 0.81-2.31), or immediate postmastectomy breast reconstruction (OR 1.27, CI 0.86-1.88), when compared with non-Hispanic ethnicity, after controlling for patient age, insurance status, and distance traveled. Conclusions: Surgical care was similar for Hispanic and non-Hispanic patients treated at our NCI-designated cancer center. However, this Hispanic population traveled further than non-Hispanic patients. Our findings suggest that accessibility to transportation and institutional practices are instrumental in delivering equitable breast cancer surgical care for Hispanic patients.

  View details for PubMedID 30283856

• Hispanic Breast Cancer Patients Travel Further for Equitable Surgical Care at a Comprehensive Cancer Center HEALTH EQUITY Yang, R. L., Wapnir, I. 2018; 2 (1): 109–16

  View details for DOI 10.1089/heq.2017.0021

  View details for Web of Science ID 000617436500017

• Addressing Inherited Predisposition for Breast Cancer in Transplant Recipients JOURNAL OF SURGICAL ONCOLOGY Yang, R. L., Kurian, A. W., Winton, L. M., Weill, D., Patel, K., Kingham, K., Wapnir, I. L. 2016; 113 (6): 605-608

  Abstract

  Consideration of prophylactic mastectomy surgery following transplantation requires complex medical decision-making, and bias against elective surgery exists because of concern for post-operative complications. Prevention of cancer in transplant recipients is of utmost importance, given the risks of treating malignancy in an immunosuppressed patient. We present a patient case and review of the literature to support a thorough pre-transplantation evaluation of family history and consideration of prophylactic interventions to safeguard the quality of life of transplant recipients. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/jso.24193

  View details for PubMedID 26861253

• Surgical Breast Cancer Care for Hispanic Patients Who Travel to an Academic Cancer Center Yang, R., Rhoads, K., Wapnir, I. SPRINGER. 2016: 172–73

  View details for Web of Science ID 000384566800169

• DCIS in BRCA1 and BRCA2 mutation carriers: prevalence, phenotype, and expression of oncodrivers C-MET and HER3 JOURNAL OF TRANSLATIONAL MEDICINE Yang, R. L., Mick, R., Lee, K., Graves, H. L., Nathanson, K. L., Domchek, S. M., Kelz, R. R., Zhang, P. J., Czerniecki, B. J. 2015; 13: 335

  Abstract

  Studies report conflicting evidence regarding the existence of a DCIS-associated premalignant pathway in BRCA mutation carriers. We aimed to examine the prevalence, phenotype, and expression of oncodrivers in pure DCIS (pDCIS) and invasive breast cancer with concurrent DCIS (IBC + DCIS) in mutation carriers.A cohort of BRCA1 and BRCA2 mutation carriers >18 years old who underwent surgery for breast cancer at an academic hospital (1992-2011) and had pathology available for review were included for study. Invasive breast cancer (IBC) and DCIS were stained for ER, PR, HER1, HER2, and HER3, and C-MET. DCIS prevalence was evaluated. Correlation of IBC and DCIS phenotypes was evaluated in patients with IBC + DCIS. DCIS and IBC expression of tumor markers were examined by BRCA mutation.We identified 114 breast tumors. Of all BRCA1-associated tumors, 21.1 % were pDCIS and 63.4 % were IBC + DCIS. Of all BRCA2-associated tumors, 23.3 % were pDCIS and 60.5 % were IBC + DCIS. In BRCA1 and BRCA2 mutation carriers with IBC + DCIS, there was a significant correlation in ER, PR, and HER3 expression between the DCIS and IBC components. Most BRCA1-associated DCIS did not express ER, PR or HER2, while most BRCA2-associated DCIS did express ER and PR. BRCA1- as well as BRCA2-associated DCIS had expression of HER3 and C-MET.The majority of BRCA-associated tumors had DCIS present. Concordance of DCIS and IBC phenotypes was high, arguing for the existence of a DCIS-associated premalignant pathway. Oncodrivers HER3 and C-MET were expressed in the DCIS of mutation carriers, suggesting an opportunity for prevention strategies.

  View details for DOI 10.1186/s12967-015-0698-3

  View details for Web of Science ID 000363292700001

  View details for PubMedID 26496879

  View details for PubMedCentralID PMC4619378

• Progressive loss of anti-HER2 CD4+ T-helper type 1 response in breast tumorigenesis and the potential for immune restoration. Oncoimmunology Datta, J., Rosemblit, C., Berk, E., Showalter, L., Namjoshi, P., Mick, R., Lee, K. P., Brod, A. M., Yang, R. L., Kelz, R. R., Fitzpatrick, E., Hoyt, C., Feldman, M. D., Zhang, P. J., Xu, S., Koski, G. K., Czerniecki, B. J. 2015; 4 (10): e1022301

  Abstract

  Genomic profiling has identified several molecular oncodrivers in breast tumorigenesis. A thorough understanding of endogenous immune responses to these oncodrivers may provide insights into immune interventions for breast cancer (BC). We investigated systemic anti-HER2/neu CD4+ T-helper type-1 (Th1) responses in HER2-driven breast tumorigenesis. A highly significant stepwise Th1 response loss extending from healthy donors (HD), through HER2pos-DCIS, and ultimately to early stage HER2pos-invasive BC patients was detected by IFNγ ELISPOT. The anti-HER2 Th1 deficit was not attributable to host-level T-cell anergy, loss of immune competence, or increase in immunosuppressive phenotypes (Treg/MDSCs), but rather associated with a functional shift in IFNγ:IL-10-producing phenotypes. HER2high, but not HER2low, BC cells expressing IFNγ/TNF-α receptors were susceptible to Th1 cytokine-mediated apoptosis in vitro, which could be significantly rescued by neutralizing IFNγ and TNF-α, suggesting that abrogation of HER2-specific Th1 may reflect a mechanism of immune evasion in HER2-driven tumorigenesis. While largely unaffected by cytotoxic or HER2-targeted (trastuzumab) therapies, depressed Th1 responses in HER2pos-BC patients were significantly restored following HER2-pulsed dendritic cell (DC) vaccinations, suggesting that this Th1 defect is not "fixed" and can be corrected by immunologic interventions. Importantly, preserved anti-HER2 Th1 responses were associated with pathologic complete response to neoadjuvant trastuzumab/chemotherapy, while depressed responses were observed in patients incurring locoregional/systemic recurrence following trastuzumab/chemotherapy. Monitoring anti-HER2 Th1 reactivity following HER2-directed therapies may identify vulnerable subgroups at risk of clinicopathologic failure. In such patients, combinations of existing HER2-targeted therapies with strategies to boost anti-HER2 CD4+ Th1 immunity may decrease the risk of recurrence and thus warrant further investigation.

  View details for DOI 10.1080/2162402X.2015.1022301

  View details for PubMedID 26451293

  View details for PubMedCentralID PMC4589053

• Progressive loss of anti-HER2 CD4(+) T-helper type 1 response in breast tumorigenesis and the potential for immune restoration ONCOIMMUNOLOGY Datta, J., Rosemblit, C., Berk, E., Showalter, L., Namjoshi, P., Mick, R., Lee, K. P., Brod, A. M., Yang, R. L., Kelz, R. R., Fitzpatrick, E., Hoyt, C., Feldman, M. D., Zhang, P. J., Xu, S., Koski, G. K., Czerniecki, B. J. 2015; 4 (10)

  Abstract

  Genomic profiling has identified several molecular oncodrivers in breast tumorigenesis. A thorough understanding of endogenous immune responses to these oncodrivers may provide insights into immune interventions for breast cancer (BC). We investigated systemic anti-HER2/neu CD4+ T-helper type-1 (Th1) responses in HER2-driven breast tumorigenesis. A highly significant stepwise Th1 response loss extending from healthy donors (HD), through HER2pos-DCIS, and ultimately to early stage HER2pos-invasive BC patients was detected by IFNγ ELISPOT. The anti-HER2 Th1 deficit was not attributable to host-level T-cell anergy, loss of immune competence, or increase in immunosuppressive phenotypes (Treg/MDSCs), but rather associated with a functional shift in IFNγ:IL-10-producing phenotypes. HER2high, but not HER2low, BC cells expressing IFNγ/TNF-α receptors were susceptible to Th1 cytokine-mediated apoptosis in vitro, which could be significantly rescued by neutralizing IFNγ and TNF-α, suggesting that abrogation of HER2-specific Th1 may reflect a mechanism of immune evasion in HER2-driven tumorigenesis. While largely unaffected by cytotoxic or HER2-targeted (trastuzumab) therapies, depressed Th1 responses in HER2pos-BC patients were significantly restored following HER2-pulsed dendritic cell (DC) vaccinations, suggesting that this Th1 defect is not "fixed" and can be corrected by immunologic interventions. Importantly, preserved anti-HER2 Th1 responses were associated with pathologic complete response to neoadjuvant trastuzumab/chemotherapy, while depressed responses were observed in patients incurring locoregional/systemic recurrence following trastuzumab/chemotherapy. Monitoring anti-HER2 Th1 reactivity following HER2-directed therapies may identify vulnerable subgroups at risk of clinicopathologic failure. In such patients, combinations of existing HER2-targeted therapies with strategies to boost anti-HER2 CD4+ Th1 immunity may decrease the risk of recurrence and thus warrant further investigation.

  View details for DOI 10.1080/2162402X.2015.1022301

  View details for Web of Science ID 000360241200001

  View details for PubMedCentralID PMC4589053

• Impact of histological subtype on long-term outcomes of neuroendocrine carcinoma of the breast BREAST CANCER RESEARCH AND TREATMENT Cloyd, J. M., Yang, R. L., Allison, K. H., Norton, J. A., Hernandez-Boussard, T., Wapnir, I. L. 2014; 148 (3): 637-644

  Abstract

  Although rare, neuroendocrine carcinoma of the breast (NECB) is becoming an increasingly recognized entity. The current literature is limited to case reports and small series and therefore a comprehensive population-based analysis was conducted to investigate the clinicopathologic features and long-term outcomes associated with NECB. We included all patients in the SEER Database from 2003 to 2010 with a diagnosis of NECB. The 2012 WHO classification system was used to categorize patients based on histopathologic diagnosis: well-differentiated neuroendocrine tumors, small/oat cell or poorly differentiated neuroendocrine tumors, adenocarcinoma with neuroendocrine features (ANF), large cell neuroendocrine and carcinoid tumors. Survival analysis was performed for disease specific (DSS) and overall (OS) survival. Of the 284 cases identified, 52.1% were classified as well-differentiated, 25.7% small cell, 14.8% ANF, 4.9% large cell, and 2.5% carcinoid. In general, patients presented with advanced disease: 36.2% had positive lymph node metastases and 20.4% presented with systemic metastases. Five-year DSS rates for stage I-IV NECB were 88.1, 67.8, 60.5, and 12.4%, respectively, while five-year OS rates were 77.9, 57.3, 52.9, and 8.9%, respectively. DSS and OS were significantly different for well-differentiated neuroendocrine tumors and ANFs compared to small cell and carcinoid tumors. On univariate Cox proportional hazards regression, small cell carcinoma was significantly associated with worse DSS (OR 1.97, 95% CI 1.05-3.67) and OS (OR 2.66, 95% CI 1.49-4.72) compared to other neuroendocrine tumors. NECB is associated with advanced stage disease at presentation and an unfavorable prognosis for stage II-IV disease and small cell, large cell, and carcinoid histologic subtypes.

  View details for DOI 10.1007/s10549-014-3207-0

  View details for Web of Science ID 000345370600018

• Impact of histological subtype on long-term outcomes of neuroendocrine carcinoma of the breast. Breast cancer research and treatment Cloyd, J. M., Yang, R. L., Allison, K. H., Norton, J. A., Hernandez-Boussard, T., Wapnir, I. L. 2014; 148 (3): 637-644

  Abstract

  Although rare, neuroendocrine carcinoma of the breast (NECB) is becoming an increasingly recognized entity. The current literature is limited to case reports and small series and therefore a comprehensive population-based analysis was conducted to investigate the clinicopathologic features and long-term outcomes associated with NECB. We included all patients in the SEER Database from 2003 to 2010 with a diagnosis of NECB. The 2012 WHO classification system was used to categorize patients based on histopathologic diagnosis: well-differentiated neuroendocrine tumors, small/oat cell or poorly differentiated neuroendocrine tumors, adenocarcinoma with neuroendocrine features (ANF), large cell neuroendocrine and carcinoid tumors. Survival analysis was performed for disease specific (DSS) and overall (OS) survival. Of the 284 cases identified, 52.1% were classified as well-differentiated, 25.7% small cell, 14.8% ANF, 4.9% large cell, and 2.5% carcinoid. In general, patients presented with advanced disease: 36.2% had positive lymph node metastases and 20.4% presented with systemic metastases. Five-year DSS rates for stage I-IV NECB were 88.1, 67.8, 60.5, and 12.4%, respectively, while five-year OS rates were 77.9, 57.3, 52.9, and 8.9%, respectively. DSS and OS were significantly different for well-differentiated neuroendocrine tumors and ANFs compared to small cell and carcinoid tumors. On univariate Cox proportional hazards regression, small cell carcinoma was significantly associated with worse DSS (OR 1.97, 95% CI 1.05-3.67) and OS (OR 2.66, 95% CI 1.49-4.72) compared to other neuroendocrine tumors. NECB is associated with advanced stage disease at presentation and an unfavorable prognosis for stage II-IV disease and small cell, large cell, and carcinoid histologic subtypes.

  View details for DOI 10.1007/s10549-014-3207-0

  View details for PubMedID 25399232

• PREDICT: Instituting an Educational Time Out in the Operating Room. Journal of graduate medical education Yang, R. L., Esquivel, M., Erdrich, J., Lau, J., Melcher, M. L., Wapnir, I. L. 2014; 6 (2): 382-383

  View details for DOI 10.4300/JGME-D-14-00086.1

  View details for PubMedID 24949168