Scholars@Duke
Eun-Sil Shelley Hwang

Eun-Sil Shelley Hwang

Mary and Deryl Hart Distinguished Professor of Surgery, in the School of Medicine
Surgical Oncology

Scholarly Works - Conferences

The role of tumor phenotype in the surgical treatment of early-stage breast cancer.

Conference Am J Surg · January 2023 BACKGROUND: We investigated whether tumor phenotype influences surgical decision-making, and how that may impact overall survival (OS) for early-stage breast cancer. METHODS: Women aged 18-69 with cT0-2/cN0/cM0 breast cancer in the National Cancer Database ... Full text Link to item Cite

Abstract PR002: Genomic predictor can discriminate between high- and low-risk DCIS

Conference Cancer Prevention Research · December 1, 2022 AbstractIntroduction: Ductal carcinoma in situ (DCIS) is considered a non-obligate precursor of invasive ductal carcinoma. With the aim of preventing a subsequent invasive cancer, all DCIS lesions are curren ... Full text Cite

Reprogramming of fibrotic macrophages to control DCIS progression

Conference CANCER PREVENTION RESEARCH · December 2022 Link to item Cite

Reprogramming of fibrotic macrophages to control DCIS progression

Conference CANCER PREVENTION RESEARCH · December 1, 2022 Link to item Cite

Genomic predictor can discriminate between high- and low-risk DCIS

Conference CANCER PREVENTION RESEARCH · December 1, 2022 Link to item Cite

The Influence of Body Mass Index on the Histopathology and Outcomes of Patients Diagnosed with Atypical Breast Lesions.

Conference Ann Surg Oncol · October 2022 BACKGROUND: Multiple studies have demonstrated a link between obesity and breast cancer; however, the potential association between obesity and atypical high-risk breast lesions has not been well characterized. We sought to evaluate the characteristics and ... Full text Link to item Cite

Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast.

Conference J Surg Oncol · May 2022 BACKGROUND: Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated the association of surgery and therapies with OS. METHODS: We utilized the ... Full text Link to item Cite

A web-based personalized decision support tool for patients diagnosed with ductal carcinoma in situ: development, content evaluation, and usability testing.

Conference Breast Cancer Res Treat · April 2022 PURPOSE: Patients diagnosed with ductal carcinoma in situ (DCIS) face trade-offs when deciding among different treatments, including surgery, radiation, and endocrine therapy. A less chosen option is active monitoring. While evidence from clinical trials i ... Full text Link to item Cite

Disease characteristics and mortality among Asian women with breast cancer.

Conference Cancer · March 1, 2022 BACKGROUND: Asian women with breast cancer are often studied in aggregate, belying significant intragroup diversity. The authors sought to examine differences in breast cancer characteristics and outcomes among Asian women. METHODS: Asian, non-Hispanic Bla ... Full text Link to item Cite

Automated Dcis Identification From Multiplex Immunohistochemistry Using Generative Adversarial Networks

Conference Proceedings International Symposium on Biomedical Imaging · January 1, 2022 Ductal Carcinoma In Situ (DCIS) is a non-obligatory precursor of Invasive Breast Cancer. It is the most common mammographically detected breast cancer. Predicting DCIS progression to invasive ductal carcinoma is a major clinical challenge due to the lack o ... Full text Cite

DCIS AI-TIL: Ductal Carcinoma In Situ Tumour Infiltrating Lymphocyte Scoring Using Artificial Intelligence

Conference Lecture Notes in Computer Science Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics · January 1, 2022 Tumour infiltrating lymphocytes (TIL) influence the prognosis of Ductal carcinoma in situ (DCIS). Currently, manual assessment of TIL by expert pathologists is considered a gold standard. However, there are issues with a shortage of expert pathologists and ... Full text Cite

Unmasking the immune microecology of ductal carcinoma in situ with deep learning

Conference Npj Breast Cancer · December 1, 2021 Despite increasing evidence supporting the clinical relevance of tumour infiltrating lymphocytes (TILs) in invasive breast cancer, TIL spatial variability within ductal carcinoma in situ (DCIS) samples and its association with progression are not well unde ... Full text Cite

Survival Outcomes Among Patients with Metastatic Breast Cancer: Review of 47,000 Patients.

Conference Ann Surg Oncol · November 2021 BACKGROUND: Although metastatic breast cancer (MBC) remains incurable, advances in therapies have improved survival. Using a contemporary dataset of de novo MBC patients, we explore how overall (OS) and cancer-specific survival (CSS) changed over time. MET ... Full text Link to item Cite

Factors Associated with Nodal Pathologic Complete Response Among Breast Cancer Patients Treated with Neoadjuvant Chemotherapy: Results of CALGB 40601 (HER2+) and 40603 (Triple-Negative) (Alliance).

Conference Ann Surg Oncol · October 2021 BACKGROUND: De-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) requires careful patient selection. We seek to determine predictors of nodal pathologic complete response (ypN0) among patients treated on CALGB 40601 or 40603, which tested ... Full text Link to item Cite

Mortality in Older Patients with Breast Cancer Undergoing Breast Surgery: How Low is "Low Risk"?

Conference Ann Surg Oncol · October 2021 BACKGROUND: Breast surgery carries a low risk of postoperative mortality. For older patients with multiple comorbidities, even low-risk procedures can confer some increased perioperative risk. We sought to identify factors associated with postoperative mor ... Full text Link to item Cite

Contralateral Axillary Nodal Metastases: Stage IV Disease or a Manifestation of Progressive Locally Advanced Breast Cancer?

Conference Ann Surg Oncol · October 2021 BACKGROUND: Contralateral axillary nodal metastases (CAM) is classified as stage IV disease, although many centers treat CAM with curative intent. We hypothesized that patients with CAM, treated with multimodality therapy, would have improved overall survi ... Full text Link to item Cite

A stiff stroma stimulates inflammation to promote breast tumor progression

Conference INTERNATIONAL JOURNAL OF EXPERIMENTAL PATHOLOGY · August 2021 Link to item Cite

Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women.

Conference Cancer · July 15, 2021 BACKGROUND: The North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) provides breast cancer screening services to underserved women to mitigate disparities in access to care. The authors sought to characterize this understudied population. ... Full text Link to item Cite

Abstract PR02: Inferring the evolutionary dynamics of ductal carcinoma in situ through multi-regional sequencing and mathematical modeling

Conference Cancer Research · November 1, 2020 AbstractIntroduction. The natural history of preinvasive breast cancer, or ductal carcinoma in situ (DCIS) remains poorly understood. Overcoming this gap would allow risk-appropriate treatment for patients d ... Full text Cite

Abstract A90: Blocking proinvasive signaling and inflammatory activation in triple-negative breast cancer with nucleic-acid scavengers (NAS)

Conference Cancer Immunology Research · March 1, 2020 AbstractBreast cancers (BC) remain the most lethal malignancies among women worldwide and the second leading cause of cancer-related mortalities in the US. Subtype heterogeneity and aggressive invasive poten ... Full text Cite

Abstract P3-08-10: Characterization of oncotype DX recurrence score and chemotherapy utilization patterns in young women (≤40) with early stage ER+/HER-, lymph node negative breast cancer

Conference Cancer Research · February 15, 2020 AbstractBackground: Meta-analyses have demonstrated that young women ≤40 (YW) derive the most benefit from chemotherapy (EBCTCG, Lancet. 1998). Oncotype DX was designed to determine the benefit of chemothera ... Full text Cite

Abstract P5-14-17: Musculoskeletal side effects over time and association with adherence in women taking neoadjuvant letrozole for estrogen receptor positive DCIS: CALGB 40903 (Alliance)

Conference Cancer Research · February 15, 2020 AbstractBackground: Side effects of and adherence to aromatase inhibitors in women with ductal carcinoma in situ are not well described. Methods: Postmenopausal women in a prospective phase II study of neoad ... Full text Cite

Abstract P1-21-07: The Patient-reported Outcomes after Routine Treatment of Atypical Lesions (PORTAL) study: Pain, psychosocial wellbeing, and quality of life among women undergoing guideline concordant care for DCIS vs. active surveillance for in situ and atypical lesions

Conference Cancer Research · February 15, 2020 AbstractBackground: Guideline-concordant care (GCC) for DCIS includes surgery, radiation, and endocrine treatment. Active surveillance (AS) is a strategy under study for management of low risk DCIS. The PORT ... Full text Cite

Axillary lymph node dissection in node-positive breast cancer: are ten nodes adequate and when is enough, enough?

Conference Breast Cancer Res Treat · February 2020 PURPOSE: National guidelines define adequate axillary lymph node dissections as those yielding ≥ 10 lymph nodes (LNs). We aimed to identify the optimal LN yield among node-positive patients. METHODS: Using the National Cancer Data Base (2010-2015), we cate ... Full text Link to item Cite

Breast cancer tumor histopathology, stage at presentation, and treatment in the extremes of age.

Conference Breast Cancer Res Treat · February 2020 BACKGROUND: Given presumed differences in disease severity between young (≤ 45 years) and elderly (≥ 75 years) women with breast cancer, we sought to compare tumor histopathology, stage at presentation, patterns of care, and survival at the extremes of age ... Full text Link to item Cite

Microcalcification localization and cluster detection using unsupervised convolutional autoencoders and structural similarity index

Conference Progress in Biomedical Optics and Imaging Proceedings of SPIE · January 1, 2020 Detecting microcalcification clusters in mammograms is important to the diagnosis of breast diseases. Previous studies which mainly focused on supervised methods require abundant annotated training data but these data are usually hard to acquire. In this w ... Full text Cite

A multitask deep learning method in simultaneously predicting occult invasive disease in ductal carcinoma in-situ and segmenting microcalcifications in mammography

Conference Progress in Biomedical Optics and Imaging Proceedings of SPIE · January 1, 2020 We proposed a two-branch multitask learning convolutional neural network to solve two different but related tasks at the same time. Our main task is to predict occult invasive disease in biopsy proven Ductal Carcinoma in-situ (DCIS), with an auxiliary task ... Full text Cite

Decreasing rates of axillary lymph node dissections over time: Implications for surgical resident exposure and operative skills development.

Conference Am J Surg · October 2019 BACKGROUND: Sentinel lymph node biopsy has supplanted axillary lymph node dissection (ALND) in clinically node-negative breast cancer and select node-positive disease. We hypothesized a decreasing rate of both ALND and resident exposure over time. METHODS: ... Full text Link to item Cite

DCIS with Microinvasion: Is It In Situ or Invasive Disease?

Conference Ann Surg Oncol · October 2019 BACKGROUND: Ductal carcinoma in situ (DCIS) with microinvasion (DCISM) can be challenging in balancing the risks of overtreatment versus undertreatment. We compared DCISM, pure DCIS, and small volume (T1a) invasive ductal carcinoma (IDC) as related to hist ... Full text Link to item Cite

Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy in Node-Positive Invasive Lobular Carcinoma.

Conference Ann Surg Oncol · October 2019 BACKGROUND: Neoadjuvant chemotherapy (NACT) is often recommended for patients with node-positive invasive lobular carcinoma (ILC) despite unclear benefit in this largely hormone receptor-positive (HR+) group. We sought to compare overall survival (OS) betw ... Full text Link to item Cite

Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons.

Conference Ann Surg Oncol · October 2019 BACKGROUND: Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS: We conducted a self-administered, ... Full text Link to item Cite

Variability in diagnostic threshold for comedo necrosis among breast pathologists: implications for patient eligibility for active surveillance trials of ductal carcinoma in situ.

Conference Mod Pathol · September 2019 Active surveillance trials for low-risk ductal carcinoma in situ (DCIS) are in progress in the United States and Europe. In some of these trials, the presence of comedo necrosis in the DCIS has been an exclusion criterion for trial entry. However, the mini ... Full text Link to item Cite

Impact of Adjuvant Trastuzumab on Locoregional Failure Rates in the NCCTG N9831 (Alliance) Study

Conference International Journal of Radiation Oncology*Biology*Physics · September 2019 Full text Cite

Abstract CT220: Expansion into multiple institutions for training in the use of the LUM Imaging System for intraoperative detection of residual cancer in the tumor bed of female subjects with breast cancer

Conference Cancer Research · July 1, 2019 AbstractBackground: Obtaining tumor-free margins is critical for local control in breast conserving surgery. Currently, 20-40% of lumpectomy patients have positive margins that require surgical re-excisio ... Full text Cite

Abstract PD6-08: Medicare costs for women after breast cancer: Preparing for survivorship

Conference Cancer Research · February 15, 2019 AbstractBACKGROUNDImprovements in breast cancer survival and increasing population life expectancy have resulted in a growing number of women receiving subsequent health care ... Full text Cite

Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities.

Conference Psychooncology · February 2019 OBJECTIVE: Women with unilateral, early-stage breast cancer and low genetic risk are increasingly opting for contralateral prophylactic mastectomy (CPM), a concerning trend because CPM offers few clinical benefits while increasing risks of surgical complic ... Full text Link to item Cite

Financial Burden Related to Decisions for Breast Cancer Surgery

Conference JOURNAL OF WOMENS HEALTH · November 1, 2018 Link to item Cite

Axillary Nodal Evaluation in Elderly Breast Cancer Patients: Potential Effects on Treatment Decisions and Survival.

Conference Ann Surg Oncol · October 2018 BACKGROUND: Recent studies suggest that surgical lymph node (LN) evaluation may be omitted in select elderly breast cancer patients as it may not influence adjuvant therapy decisions. To evaluate differences in adjuvant therapy receipt and overall survival ... Full text Link to item Cite

Extent of axillary surgery in women with Stage IV breast cancer

Conference ANNALS OF SURGICAL ONCOLOGY · June 1, 2018 Link to item Cite

Molecular determinants of post-mastectomy breast cancer recurrence.

Conference NPJ Breast Cancer · 2018 Breast cancer (BC) adjuvant therapy after mastectomy in the setting of 1-3 positive lymph nodes has been controversial. This retrospective Translational Breast Cancer Research Consortium study evaluated molecular aberrations in primary cancers associated w ... Full text Link to item Cite

Learning better deep features for the prediction of occult invasive disease in ductal carcinoma in situ through transfer learning

Conference Progress in Biomedical Optics and Imaging Proceedings of SPIE · January 1, 2018 Purpose: To determine whether domain transfer learning can improve the performance of deep features extracted from digital mammograms using a pre-trained deep convolutional neural network (CNN) in the prediction of occult invasive disease for patients with ... Full text Cite

Deep learning-based features of breast MRI for prediction of occult invasive disease following a diagnosis of ductal carcinoma in situ: Preliminary data

Conference Progress in Biomedical Optics and Imaging Proceedings of SPIE · January 1, 2018 Approximately 25% of patients with ductal carcinoma in situ (DCIS) diagnosed from core needle biopsy are subsequently upstaged to invasive cancer at surgical excision. Identifying patients with occult invasive disease is important as it changes treatment a ... Full text Cite

Improving classification with forced labeling of other related classes: Application to prediction of upstaged ductal carcinoma in situ using mammographic features

Conference Progress in Biomedical Optics and Imaging Proceedings of SPIE · January 1, 2018 Predicting whether ductal carcinoma in situ (DCIS) identified at core biopsy contains occult invasive disease is an import task since these "upstaged" cases will affect further treatment planning. Therefore, a prediction model that better classifies pure D ... Full text Cite

The Financial Burden of Breast Cancer Treatment

Conference JOURNAL OF WOMENS HEALTH · September 1, 2017 Link to item Cite

Abstract P1-06-06: Evidence for tumor heterogeneity and clonal evolution during invasive progression of breast cancer

Conference Cancer Research · February 15, 2017 AbstractPurpose: Intratumoral heterogeneity is well recognized to be an important driver of treatment resistance and metastasis. We undertook this N of one study to measure the degree of heterogeneity in a s ... Full text Cite

H3K27me3 Expression and X Chromosome Inactivation in Breast Carcinoma

Conference LABORATORY INVESTIGATION · February 1, 2017 Link to item Cite

Prediction of occult invasive disease in ductal carcinoma in situ using computer-extracted mammographic features

Conference Progress in Biomedical Optics and Imaging Proceedings of SPIE · January 1, 2017 Predicting the risk of occult invasive disease in ductal carcinoma in situ (DCIS) is an important task to help address the overdiagnosis and overtreatment problems associated with breast cancer. In this work, we investigated the feasibility of using comput ... Full text Cite

Can upstaging of ductal carcinoma in situ be predicted at biopsy by histologic and mammographic features?

Conference Progress in Biomedical Optics and Imaging Proceedings of SPIE · January 1, 2017 Reducing the overdiagnosis and overtreatment associated with ductal carcinoma in situ (DCIS) requires accurate prediction of the invasive potential at cancer screening. In this work, we investigated the utility of pre-operative histologic and mammographic ... Full text Cite

DCIS-Conservative Nonsurgical Management- The Problem of Over-diagnosis: What is the Path Forward?

Conference MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY · December 1, 2016 Link to item Cite

Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy.

Conference J Clin Oncol · May 1, 2016 PURPOSE: The rate of contralateral prophylactic mastectomies (CPMs) continues to rise, although there is little evidence to support improvement in quality of life (QOL) with CPM. We sought to ascertain whether patient-reported outcomes and, more specifical ... Full text Link to item Cite

Abstract P5-17-03: The 12-gene DCIS score assay: Impact on radiation treatment (XRT) recommendations and clinical utility

Conference Cancer Research · February 15, 2016 AbstractBackground: In the management of DCIS clinicians and patients (pts) must choose between the various options for breast conservation treatment based on an assessment of local recurrence (LR) risk. Tra ... Full text Cite

Abstract ES8-3: Endocrine management of premalignant lesions and DCIS

Conference Cancer Research · February 15, 2016 AbstractIt has been recognized for many years that there exist pathological entities associated with an increased risk of invasive breast cancer. The most frequently encountered are atypical hyperplasia (AH) ... Full text Cite

Preoperative Partial Breast Radiation Therapy: Short-term Imaging Outcomes With Two Unique Treatment Regimens

Conference International Journal of Radiation Oncology*Biology*Physics · November 2015 Full text Cite

Abstract P1-10-02: Adjuvant radiation after lumpectomy: A cost comparison of treatment patterns in 43,247 women from the National Cancer Data Base

Conference Cancer Research · May 1, 2015 AbstractBACKGROUND: Breast cancer treatment contributes the greatest proportion of cancer-related health care spending in the United States. Locoregional therapy comprises a significant share of these costs. ... Full text Cite

Abstract P3-07-22: Predictors of neoadjuvant chemotherapy use in women with breast cancer: A review of 169,329 patients from the American College of Surgeons' National Cancer Database

Conference Cancer Research · May 1, 2015 AbstractBackground: Randomized controlled trials have demonstrated that neoadjuvant chemotherapy (NAC) offers equivalent long-term outcomes when compared to adjuvant chemotherapy while improving rates of bre ... Full text Cite

The current clinical value of the DCIS Score.

Conference Oncology (Williston Park) · May 2014 The management of ductal carcinoma in situ (DCIS) can be controversial. Widespread adoption of mammographic screening has made DCIS a more frequent diagnosis, and increasingly smaller, lower-grade lesions are being detected. DCIS is commonly treated with b ... Link to item Cite

Incidence Patterns of Breast Cancer among Women 35 and Younger at Diagnosis

Conference ANNALS OF SURGICAL ONCOLOGY · February 1, 2014 Link to item Cite

Abstract P5-14-04: Preoperative single-fraction partial breast radiotherapy – Initial results from a novel phase I dose-escalation protocol with exploration of radiation response biomarkers

Conference Cancer Research · December 15, 2013 AbstractPurpose/Objectives(s): Women with biologically favorable early stage breast cancer are increasingly treated with accelerated partial breast techniques. However, many alternative techniques require co ... Full text Cite