Breast Surgical Techniques and Interdisciplinary Management

Frederick M. Dirbas, MD, Associate Professor of Surgery, Stanford University Medical Center, Stanford Cancer Institute, Palo Alto, CA, USAMark D. Pegram, MD, Professor of Medical Oncology, Stanford University Medical Center, Stanford Cancer Institute, Palo Alto, CA, USAKathleen Horst, MD, Professor of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA

• Professionalism.- Multidisiciplinary Care.- Team Members and Roles.- Hx and CBE: Likely benign vs likely malignant findings.- Documentation and Legal Issues.- Practice Management.- Patient Satisfaction Scoring Systems.- Career Development for Breast Surgery.- Breast Pain.- Gynecomastia.- Nipple Discharge.- Breast Infections.- Breast Mass.- Axillary Mets w/o Primary.- Eval during Preg.- Incorporating the Family History into the Workup.- Hormonal Therapy and Breast Cancer Risk.- Office Based Diagnostic Procedures.- Breast Ultrasound in the Surgeons Office as an Adjunct to the Clinical  Exam, Diagnostic Procedures and Therepeutic Excisions.- Ductoscopy.- Breast Cytology.- Evolving Role of Mammography, US.- Breast MRI.- Focus on Imaging of the Axilla for Pathologic Nodes.- Special Considerations for Breast Imaging following Augmentation or Breast Reconstruction.- Image Guided Breast Biopsy of the Breast and Regional Nodes: FNA vs Core, Marker vs No Marker.- Technical Considerations in Percutaneous biopsy for Metastatic Disease.- Future Possibilities for Functional Imaging of Breast Cancer.- Imaging for Metastatic Disease: Bone scans, CT scans and PET/CT.- Breast Imaging, Navigating Complex CBE and Multiple Imaging Abnormalities.- Biology of Br CA - Overview.- Benign Histology (including current recs for "borderline lesions", PASH, and radial scar).- Gene Expression Profiling of Breast Cancer.- Subtypes of Triple Negative (ER/PR/Her2) Breast Cancer.- Lessons from Next-Gen Sequencing in Breast Cancer.- Heterogeneity of the Primary Breast Tumor and Metastatic Disease.- Breast Cancer Stem Cells: A Unifying Theory.- How Important is Timing the Initiation of Breast Cancer Care.- Assessing Extent of Disease in Primary Breast Cancer.- Fertility Issues.- AJCC Staging.- Breast Cancer Treatment Guidelines.- Clinical Trial Overview, Cooperative Groups, and the Importance of Clincial Trial Enrollment.- iSPY and iSPY 2: a Novem Mechanism for Clinical Trial Design.- Assessing Patient Distress.- Supportive Care.- Psychiatric and Psychologic  Issues, Introducing the Concept of Palliative Care.- Anesthesia Issues.- Incisional, Excisional, and Wire Localized Breast Biopsy.- Lumpectomy.- Is There Emerging Consensus on What Constitutes and Adequate Surgical Margin?.- Intraoperative Techniques for Assessing Tumor-Free Margins.- Oncoplastic Techniques After Lumpectomy.- Ablative Techniques.- Total (Simple) and Modified Radical Mastectomy.- Nipple/areolar preservation.- Plastic and Reconstructive Surgery.- Surgical Considerations in the Very Young Breast Cancer Patient: Surgical Considerations During Pregnancy.- When Should Patients Consider Neoadjuvant Systemic Therapy Prior to Lumpectomy or Mastectomy?.- Special Surgical Situations: Paget's Disease.- Special Surgical Situations: Male breast cancer.- Special Surgical Situations: Sarcoma.- Working with Tissue Bank.- Lumpectomy or Mastectomy in the Setting of Metastatic Disease.- Sentinel Node Bx - overview and techniques(Radiotracer, Lymphazurin, Methyelene Blue).- Is There a Role for Sentinel Node Biopsy Alone?.- Is Axillary Radiotherapy a Substitute for Completion Axillary Node Dissection?.- Is there a role for Sentinel Node Biopsy after Neoadjuvant Therapy in Patients with Clinical Resolution of Involved Axillary Nodes?.- Surgical Technique for a Level I/II Axillary Node Dissection.- Reverse Axillary Mapping to Avoid Lymphedema.- Components of Breast Path Report.- Path: Risk Markers.- Path: DCIS.- Path: Invasive carcinoma.- Path: Challenges in Consistency for ER/PR/Her2/Ki67 Test Results and implications for Care.- Path: Post neoadjuvant chemotherapy.- Path: Pathology of the Sentinel Node and Axillary Nodes.- Path: Breast Sarcoma.- Basic Principles of Systemic Therapy.- Neoadj Hormonal Tx.- Neoadj Chemo/Targeted Tx.- Conventional Adjuv Chemo Tx.- Targeted Therapies for Her2 positive tumors.- Targeted Therpaies for ER/PR/Her2 negative breast cancer.- Adju Hormon Tx for Endocrine Sensitive Breast Cancer.- Special Situations: Systemic Therapy During Pregnancy.- Special Situations: Breast Cancer in the Elderly.- Alternative Therapies (CAM).- Bisphonphonates as an Adjunct to Breast Cancer Care.- Prin Radiobiology.- APBI Overview.- Brachytherapy Technique.- MammoSite Technique.- 3D Conformal Technique.- Single Fraction Breast IORT.- Breast IORT as the Boost Dose.- Conventional Post Lump WB XRT.- Current Role of Hypofractionated WB-XRT.- What are Appropriate Indications for Post Surgical Regional Nodal Irradiation.- Controversial issues in breast radiotherapy.- Patient Tracking Systems.- Follow up Strategies after Breast Cancer Treatment.- Clinical Breast Exam in Treated Patients.- Diagnostic Workup in Patients with Prior Breast Conservation.- Mgmt Options with Ipsilateral Breast Tumor Recurrence.- Pregnancy After Br Ca.- Measuring Quality of Breast Cancer Care.- Survivorship Issues.- Chronic Pain Issues after Breast Surgery.- Managing Lymphedema.- Mgmt Pts with Metastases.- When Medical Treatment Is Unable to Halt Disease Progression: (Re)introducing Palliative Care and Appropriate Timing for Hospice.