Postmastectomy breast reconstruction is widely used in breast cancer patients for its aesthetic effect. Although several studies have casted suspicion upon the oncological safety of immediate breast reconstruction after mastectomy, the potential impact of different reconstruction methods on patient survival remains unclear. We identified 35,126 female patients diagnosed with breast cancer from January 1, 1998 to December 31, 2002 in the Surveillance, Epidemiology, and End Results database. Breast cancer-specific survival (BCSS) and overall survival (OS) were compared among patients who underwent mastectomy with or without immediate breast reconstruction (autologous reconstruction or implant reconstruction) using Cox proportional hazard regression models. In multivariate analysis unadjusted for family income, patients undergoing immediate postmastectomy reconstruction exhibited improved BCSS [pooled reconstruction (any types of reconstruction): hazard ratio (HR) = 0.87, 95% confidence interval (CI) 0.80–0.95, P = 0.001] and OS (pooled reconstruction: HR = 0.70, 95% CI 0.65–0.75, P<0.001) compared to patients who underwent mastectomy alone. However, after stratifying by family income, patients receiving reconstruction showed limited advantage in BCSS and OS compared with those undergoing mastectomy alone. When comparing between the two reconstruction methods, no significant differences were observed in either BCSS (implant versus autologous reconstruction: HR = 1.11, 95%CI 0.90–1.35, P = 0.330) or OS (implant versus autologous reconstruction: HR = 1.07, 95% 0.90–1.28, P = 0.424). Compared to mastectomy alone, immediate postmastectomy reconstruction had limited advantage in survival after adjusting for confounding factor of family income. Our findings, if validated in other large databases, may help to illustrate the actual effect of immediate postmastectomy reconstruction on patient survival.

Hepatocellular carcinoma (HCC) is the most common liver tumor, with a continually rising incidence. The curative treatment for HCC is surgical resection or liver transplantation; however, only a small portion of patients are eligible due to local tumor burden or underlying liver dysfunction. Most HCC patients receive nonsurgical liver-directed therapies (LDTs), including thermal ablation, transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and external beam radiation therapy (EBRT). Stereotactic ablative body radiation (SABR) is a specific type of EBRT that can precisely deliver a high dose of radiation to ablate tumor cells using a small number of treatments (or fractions, typically 5 or less). With onboard MRI imaging, MRI-guided SABR can improve therapeutic dose while minimizing normal tissue exposure. In the current review, we discuss different LDTs and compare them with EBRT, specifically SABR. The emerging MRI-guided adaptive radiation therapy has been reviewed, highlighting its advantages and potential role in HCC management.

PURPOSE: Reviewing pathology reports requires physicians to integrate complex histopathologic, immunohistochemical, and molecular findings from multiple reports and institutions, often under time constraints that increase the risk of error and fatigue. Large language models (LLMs) offer a potential solution by generating concise, coherent summaries from complex pathology data. METHODS: Patients who underwent initial consultation in a thoracic clinic between January 2019 and July 2023 were included. Original pathology reports and corresponding physician pathology summaries from consultation notes were extracted and anonymized. Six open-source LLMs (Llama 3.0, Llama 3.1, Llama 3.2, Mistral, Gemma, and DeepSeek-R1) generated pathology summaries directly from the original reports. Objective and subjective evaluations were performed using the original reports as the ground truth. LLM-generated summaries were compared with physician summaries for correctness, completeness, and conciseness. Additional subjective assessments with multiple evaluators were conducted for Llama 3.1. RESULTS: Ninety-four cases met the eligibility criteria. Using the original pathology reports as the ground truth, the LLM-generated summaries achieved higher scores across all objective evaluation metrics compared with physician pathology summaries ( P < .0001). In the subjective evaluation, DeepSeek, Mistral, Llama 3.1, and Llama 3.2 achieved higher ratings for completeness ( P = .017, P < .0001, P < .0001, and P < .0001, respectively) while maintaining comparable correctness relative to physician pathology summaries ( P = 1.000). The results remained consistent in additional subjective analyses involving multiple evaluators for Llama 3.1. CONCLUSION: LLM-generated summaries demonstrated better performance in objective metrics and greater completeness in subjective evaluations compared with physician summaries. These results highlight the potential of LLMs as valuable tools for enhancing clinical documentation and workflow efficiency in oncology practice.

Chickenpox is a common viral infection caused by Varicella-zoster virus (VZV). Pneumonia is an infrequent complication of chickenpox infection. Rarely, multiple calcified pulmonary nodules can be the sequela of healed VZV pneumonia. A middle-aged female individual was found to have diffuse incidental pulmonary micronodules. By further history inquiry and diagnosis of exclusion, her pulmonary micronodules were determined to be likely associated with prior VZV infection. VZV infection can cause calcified pulmonary nodules related to granuloma, and gold standard diagnosis is surgical lung biopsy with VZV PCR. However, diagnosis of exclusion is a reasonable approach to reach a presumptive diagnosis. Familiarity with this entity can potentially avoid invasive procedures in selected patients.

Alternative splicing (AS) and its regulation play critical roles in cancer, yet the dysregulation of AS and its molecular bases in breast cancer development have not yet been elucidated. Using an in vivo CRISPR screen targeting RNA-binding proteins, we identified PHD finger protein 5A (PHF5A) as a key splicing factor involved in tumor progression. PHF5A expression was frequently upregulated in breast cancer and correlated with poor survival, and knockdown of PHF5A significantly suppressed cell proliferation, migration, and tumor formation. PHF5A was required for SF3b spliceosome stability and linked the complex to histones, and the PHF5A–SF3b complex modulated AS changes in apoptotic signaling. In addition, expression of a short truncated FAS-activated serine/threonine kinase (FASTK) protein was increased after PHF5A ablation and facilitated Fas-mediated apoptosis. This PHF5A-modulated FASTK–AS axis was widely present in breast cancer specimens, particularly those of the triple-negative subtype. Taken together, our findings reveal that PHF5A serves as an epigenetic suppressor of apoptosis and thus provides a mechanistic basis for breast cancer progression and may be a valuable therapeutic target.Significance: This study provides an epigenetic mechanistic basis for the aggressive biology of breast cancer and identifies a translatable therapeutic target. Cancer Res; 78(12); 3190–206. ©2018 AACR.