optimization-breast-biopsy-mastectomy-sample-collection-procedures

Optimization of Breast Biopsy and Mastectomy Sample Collection Procedures for Biobanking, Personalized Medicine, and Research Applications

Breast cancer is the most prevalent cancer affecting women, particularly in Asia, with the highest incidence in the Philippines. Despite ongoing efforts, ...

University of the Philippines

We documented the initial experience in our institution where we used indocyanine green (ICG) fluorescence angiography as adjunct in the evaluation of the vascular supply of a reconstructed gastric conduit for esophageal replacement for esophagogastric junction (EGJ) cancer surgery.

Indocyanine Green (ICG) fluorescence angiography of gastric conduit after transhiatal thoracic esophagectomy with proximal gastrectomy for esophagogastric junction adenocarcinoma: A case report and initial experience at a tertiary government hospital in the Philippines.

This study examines effectiveness of a donated Laerdal Virtual I.V. simulator when compared with traditional methods of teaching intravenous (IV) cannulation to third year medical students in the Philippines. Forty novice Filipino medical students viewed an instructional video on how to start intravenous lines and were then randomly divided into two groups of twenty. The "Traditional" group observed an IV insertion on an actual patient performed by an experienced practitioner, and then subsequently performed an IV on an actual patient which was videotaped. The "Simulation" group practiced the Virtual I.V. simulator until they successfully completed level three using the "doctor" setting. These students then performed an IV on an actual patient which was videotaped. The videotapes for both groups were reviewed by two pre-trained (Inter-rater reliability of > or =0.84) observers who were blinded to the group using a previously validated checklist for IV insertion. Students trained on the Virtual I.V. showed significantly greater success in successfully starting an IV on an actual patient (40% VS. 15%, p<0.05), decreased constrictive band time (p<.05), increased raw score on the check list (p<.03), and decreased overall time to start an IV (p<.05). The technology was well received but wider application in the non western world is limited by lack of in country company support and the relative expense.

Exporting simulation technology to the Philippines: a comparative study of traditional versus simulation methods for teaching intravenous cannulation.

For women with hormone receptor-positive, operable breast cancer, surgical oophorectomy plus tamoxifen is an effective adjuvant therapy. We conducted a phase III randomized clinical trial to test the hypothesis that oophorectomy surgery performed during the luteal phase of the menstrual cycle was associated with better outcomes.

Timing of adjuvant surgical oophorectomy in the menstrual cycle and disease-free and overall survival in premenopausal women with operable breast cancer.

One methodologic challenge in conducting research relating to diaper dermatitis (DD) is the absence of a reliable, objective, validated scale for assessing severity. The aim of this study was to develop and validate such a scale.

A New Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants: Development and Validation.

Liposarcoma is a malignant mesenchymal neoplasm composed of adipose tissue with varying degrees of atypia. These tumors grow slowly and may reach an enormous size particularly if located in the retroperitoneum. We report a 40-year-old male with a 6-month history of gradual abdominal enlargement. Computed tomography (CT) of the abdomen showed a huge retroperitoneal mass with characteristic features consistent with liposarcoma. On laparotomy, the mass was noted to be encasing the right ureter for which a wide excision with en bloc ureterectomy and subsequent renal autotransplantation for organ preservation was done. Post-operative course was uneventful with excellent outcome after 6 months of follow-up. Final histopathologic diagnosis was low-grade, well differentiated liposarcoma, which has favorable prognosis following radical surgery. This was the first report of such a case in the Philippines.

Wide Excision of a Retroperitoneal Liposarcoma with En Bloc Ureterectomy and Renal Salvage by Autotransplantation.

Biobanking has become an indispensable tool for translational research and health innovations. While the field of biobanking has progressed and evolved globally, biobanking in developing Association of Southeast Asian Nations (ASEAN) countries such as the Philippines remains underrepresented because of several challenges often encountered in these low- and middle-income countries. Recently, the Philippine government has undertaken enormous efforts to advancing research and development in the country, and one of the current research pursuits is the establishment of biobanks, with the hope of attaining more discoveries and innovations in the future. Given that cancer remains a leading cause of death in the Philippines, the Philippine government supported the establishment of a cancer biobank at the Philippine General Hospital (PGH). In this study, we present a specific use case of biobanking activity at the PGH Biobank, to build a cohort of biospecimens from Filipino patients with breast, endometrial, and ovarian cancer. This initiative is part of a biomonitoring study (1) to assess environmental exposures and possible risk factors in the Philippine population and (2) to develop a system of culturing human cells from Filipino patients for subsequent  studies. We discuss issues faced and the solutions developed during the implementation of the biobank. Strong research collaboration, a funding source, basic infrastructure, and appropriate technology helped initiate this pilot biobank in the Philippines. Overall, the experiences of establishing the PGH Biobank may help other institutions in low-resource countries to set up cancer biobanks.

A Pilot Cancer-Phenome Biobanking System in a Low-Resource Southeast Asian Setting: The Philippine General Hospital Biobank Experience.

We present a 45-year-old woman with metastatic breast disease who initially presented with progressive proptosis of her right eye causing limited motility, diplopia and eye pain. MRI done showed an avidly enhancing right sphenoorbital mass causing displacement in the lateral and superior recti muscles with lysis and infiltration of the greater sphenoid wing and lateral orbital wall. The patient underwent surgery resulting in immediate relief of proptosis and resolution of symptoms. Although surgery is not recommended for orbital metastasis as it is not curative, it should be considered as a treatment option as it can provide relief to patients and improve their quality of life.

Surgery for orbital metastasis from breast carcinoma initially presenting with progressive proptosis.

We document a case of a 24-year-old gravida 2, para 1 (1001), on her second trimester, who was referred to the surgical oncology service for a palpable right hemiabdominal mass. She previously underwent wide excision of a retroperitoneal atypical lipomatous tumour 2 years ago. Her current case was successfully managed by a multidisciplinary team of doctors from the preoperative phase, the actual surgery up to the adjuvant treatment. She had a two-staged surgery: an elective lower-segment caesarean section at 34 weeks age of gestation for which she delivered a healthy baby girl and, 2 weeks after, she had excision of the huge retroperitoneal tumour recurrence. Histopathology revealed a 35 cm×25 cm×22 cm dedifferentiated liposarcoma, for which she was started on adjuvant systemic chemotherapy.

Case of a huge recurrent retroperitoneal liposarcoma diagnosed in the second trimester of pregnancy.

Several studies have reported exposure of humans to various endocrine disrupting chemicals (EDCs) worldwide. However, there is a lack of data regarding EDC exposures in humans living in Southeast Asian countries, such as the Philippines. Hence, this study measured levels of 41 EDCs in women residing in the Greater Manila Area, home to the second largest city in Southeast Asia. Urine samples from women with versus without breast cancer were analyzed for 11 phthalate metabolites, 8 environmental phenols, and 10 bisphenols, while serum samples were analyzed for 12 perfluoroalkyl substances (PFAS). Out of the four groups of EDCs analyzed, PFAS were significantly associated with breast cancer (adjusted OR = 13.63, 95% CI: 3.24-94.88 p-trend = 0.001 for PFDoA; adjusted OR = 9.26, 95% CI 2.54-45.10, p-trend = 0.002 for PFDA; and adjusted OR = 2.66, 95% CI: 0.95-7.66, p-trend = 0.004 for PFHxA). Long-chain PFAS levels were positively correlated with age and were significantly higher in women from Region IV-A, a heavily industrialized region, than from the National Capital Region. Overall, this study showed baseline information regarding the level of EDCs in Filipinas, providing a glimpse of EDC exposure in women living in a megalopolis city in Southeast Asia.

Elevated levels of perfluoroalkyl substances in breast cancer patients within the Greater Manila Area.

In the Philippines, a lower middle-income country in Southeast Asia, 6 of 10 Filipinos die without seeing a doctor. To ensure universal access to cancer care, providers must be equitably distributed. Therefore, we evaluated the distribution of oncologists across all 17 regions in the Philippines.

Geographic Distribution of Cancer Care Providers in the Philippines.

The Philippines ranks 10th in tuberculosis prevalence worldwide. Aside from pulmonary tuberculosis, GI tuberculosis remains an important cause of morbidity and mortality, particularly in endemic areas.

Surgical Management of Patients With GI Tuberculosis.

This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability.

Filipino Translation and Validation of the University of Washington - Quality of Life Questionnaire (Version 4) for Patients with Head and Neck Tumors in the Philippine General Hospital.

Lymphovascular invasion (LVI), the invasion of tumor cells into the lymphatic or vascular space, is an early indicator of potential metastasis, with its presence in breast cancer independently predicting poorer outcomes even after neoadjuvant chemotherapy. However, a major limitation is that LVI detection currently relies on postsurgical evaluation. To address this, we determined whether LVI breast tumors contain a unique gene signature that could facilitate earlier detection. Here, we conducted an integrative analysis of the gene profile between LVI and LVI primary breast tumors from various sources, including published data and our own research, using both microarray and RNA-seq data. Our analysis revealed protein binding and vesicle-related genes to be the most enriched categories in LVI vs LVI tumors. Furthermore, LVI tumors showed enrichment for xenobiotic metabolism genes, particularly drug metabolism enzymes, such as cytochrome P450 and uridine 5'-diphospho-glucuronosyltransferases. An elastic net regression model containing 13 of these uridine 5'-diphospho-glucuronosyltransferases and cytochrome P450 genes can predict LVI status with 92% accuracy. This suggests a potential link to drug resistance, which was further confirmed by the finding that patients with LVI tumors had a significantly lower clinical response rate than individuals with LVI tumors. We also observed this resistance in patient-derived organoids, with LVI organoids exhibiting lower sensitivity to doxorubicin, implying that doxorubicin might be less effective for LVI breast cancer, potentially contributing to poorer outcomes. Overall, our study unlocked an exciting opportunity for personalized medicine, in that, therapy efficacy and patient outcomes can be improved by incorporating the LVI-associated gene signature into treatment plans.

Article	Year
Indocyanine Green (ICG) fluorescence angiography of gastric conduit after transhiatal thoracic esophagectomy with proximal gastrectomy for esophagogastric junction adenocarcinoma: A case rep... International journal of surgery case reports\| PubMed ID: 33611079	2021
Exporting simulation technology to the Philippines: a comparative study of traditional versus simulation methods for teaching intravenous cannulation. Studies in health technology and informatics\| PubMed ID: 19377182	2009
Timing of adjuvant surgical oophorectomy in the menstrual cycle and disease-free and overall survival in premenopausal women with operable breast cancer. Journal of the National Cancer Institute\| PubMed ID: 25794890	2015
A New Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants: Development and Validation. Pediatric dermatology\| PubMed ID: 27653955	2016
Wide Excision of a Retroperitoneal Liposarcoma with En Bloc Ureterectomy and Renal Salvage by Autotransplantation. Case reports in transplantation\| PubMed ID: 31886012	2019
A Pilot Cancer-Phenome Biobanking System in a Low-Resource Southeast Asian Setting: The Philippine General Hospital Biobank Experience. Biopreservation and biobanking\| PubMed ID: 32202927	2020
Surgery for orbital metastasis from breast carcinoma initially presenting with progressive proptosis. BMJ case reports\| PubMed ID: 33293275	2020
Case of a huge recurrent retroperitoneal liposarcoma diagnosed in the second trimester of pregnancy. BMJ case reports\| PubMed ID: 34226256	2021
Elevated levels of perfluoroalkyl substances in breast cancer patients within the Greater Manila Area. Chemosphere\| PubMed ID: 34293563	2022
Geographic Distribution of Cancer Care Providers in the Philippines. JCO global oncology\| PubMed ID: 36332171	2022
Surgical Management of Patients With GI Tuberculosis. Diseases of the colon and rectum\| PubMed ID: 36515515	2023
Filipino Translation and Validation of the University of Washington - Quality of Life Questionnaire (Version 4) for Patients with Head and Neck Tumors in the Philippine General Hospital. Acta medica Philippina\| PubMed ID: 39484067	2023
Lymphovascular Invasion Is Associated With Doxorubicin Resistance in Breast Cancer. Laboratory investigation; a journal of technical methods and pathology\| PubMed ID: 39978641	2025

Rodney B. Dofitas

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