Scholars@Duke
Theodore Neofytos Tsangaris

Theodore Neofytos Tsangaris

Medical Associate Professor in the Department of Surgery
Surgical Oncology

Selected Publications

Does Preoperative MRI Reduce Positive Margins after Breast-Conserving Surgery?

Journal Article Ann Surg Oncol · October 2023 BACKGROUND: Breast-conserving surgery (BCS) is a mainstay for breast cancer management, and obtaining negative margins is critical. Some have advocated for the use of preoperative magnetic resonance imaging (MRI) in reducing positive margins after BCS. We ... Full text Link to item Cite

Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery: A Prospective Multicenter Randomized Controlled Trial.

Journal Article Ann Surg · May 1, 2021 OBJECTIVE: Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were ... Full text Link to item Cite

Impact of Cavity Shave Margins on Margin Status in Patients with Pure Ductal Carcinoma In Situ.

Journal Article J Am Coll Surg · April 2021 BACKGROUND: We examined the impact of cavity shave margins (CSMs) on margin status in patients with pure ductal carcinoma in situ (DCIS) undergoing partial mastectomy (PM). METHODS: One hundred and nine patients from 2 multicenter, randomized controlled tr ... Full text Link to item Cite

Nipple-sparing mastectomy: A review of outcomes at a single institution.

Journal Article Breast J · November 2020 Nipple-sparing mastectomy (NSM) offers patients who are not candidates for breast-conserving treatment an aesthetically pleasing alternative to traditional mastectomy. Some studies have demonstrated its oncologic safety while others have demonstrated resid ... Full text Link to item Cite

Is radial scar on core needle biopsy a risk factor for malignancy? A single-center retrospective review and implications for management.

Journal Article Breast J · October 2020 INTRODUCTION: Reported upgrade rate to malignancy of radial scars (RS) ranges widely (0%-40%) making management controversial. METHODS: A retrospective chart review was performed on patients with RS on core needle biopsy (CNB). Upgrade rates to malignancy ... Full text Link to item Cite

Prognostic value of HER2 status on circulating tumor cells in advanced-stage breast cancer patients with HER2-negative tumors.

Journal Article Breast Cancer Res Treat · June 2020 PURPOSE: Discordance between HER2 expression in tumor tissue (tHER2) and HER2 status on circulating tumor cells (cHER2) has been reported. It remains largely underexplored whether patients with tHER2-/cHER2+ can benefit from anti-HER2 targeted therapies. M ... Full text Link to item Cite

Association of clinical outcomes in metastatic breast cancer patients with circulating tumour cell and circulating cell-free DNA.

Journal Article Eur J Cancer · January 2019 BACKGROUND: Both circulating tumour cell (CTC) and total circulating cell-free DNA (ccfDNA) predict cancer patient prognosis. However, no study has explored the prognostic value of the combined use of CTC and ccfDNA. We aimed to investigate individual and ... Full text Link to item Cite

Do All Positive Margins in Breast Cancer Patients Undergoing a Partial Mastectomy Need to Be Resected?

Journal Article J Am Coll Surg · July 2018 BACKGROUND: Positive margins have been reported in 20% to 40% of patients undergoing a partial mastectomy, often resulting in re-excision. How often the re-excision yields additional cancer and whether there are predictors of residual disease remain unknow ... Full text Link to item Cite

Quality-of-Life Outcomes Improve with Nipple-Sparing Mastectomy and Breast Reconstruction.

Conference Plast Reconstr Surg · August 2017 BACKGROUND: Loss of the nipple-areola complex can be psychologically and sexually devastating. Nipple-sparing mastectomy provides robust cosmetic results, but few studies have investigated the quality-of-life outcomes associated with it. METHODS: The autho ... Full text Link to item Cite

Economic Impact of Routine Cavity Margins Versus Standard Partial Mastectomy in Breast Cancer Patients: Results of a Randomized Controlled Trial.

Conference Ann Surg · January 2017 OBJECTIVE: The aim of the study was to compare costs associated with excision of routine cavity shave margins (CSM) versus standard partial mastectomy (PM) in patients with breast cancer. BACKGROUND: Excision of CSM reduces re-excision rates by more than 5 ... Full text Link to item Cite

Clinical-pathological features and treatment modalities associated with recurrence in DCIS and micro-invasive carcinoma: Who to treat more and who to treat less.

Journal Article Breast · October 2016 The primary aim in the management of DCIS is the prevention of recurrence and contralateral tumor. Risk factors for DCIS recurrence and appropriate treatments are still widely debated. Adjuvant therapies after surgical resection reduce recurrences and cont ... Full text Link to item Cite

Reflex Estrogen Receptor (ER) and Progesterone Receptor (PR) Analysis of Ductal Carcinoma In Situ (DCIS) in Breast Needle Core Biopsy Specimens: An Unnecessary Exercise That Costs the United States $35 Million/y.

Journal Article Am J Surg Pathol · August 2016 Most institutions reflexively test all breast core needle biopsy specimens showing ductal carcinoma in situ (DCIS) for estrogen receptor (ER) and progesterone receptor (PR). However, 5 factors suggest that this reflex testing unnecessarily increases costs. ... Full text Link to item Cite

Intraductal Papilloma with Benign Pathology on Breast Core Biopsy: To Excise or Not?

Journal Article Ann Surg Oncol · August 2016 BACKGROUND: The management of intraductal papillomas on core biopsy continues to be controversial. Papillomas with atypia are typically excised. However, it is unclear whether surgical excision is warranted for benign lesions. METHODS: A retrospective revi ... Full text Link to item Cite

A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer.

Journal Article N Engl J Med · August 6, 2015 BACKGROUND: Routine resection of cavity shave margins (additional tissue circumferentially around the cavity left by partial mastectomy) may reduce the rates of positive margins (margins positive for tumor) and reexcision among patients undergoing partial ... Full text Link to item Cite

Reflex estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/Her2) analysis of breast cancers in needle core biopsy specimens dramatically increases health care costs.

Journal Article Am J Surg Pathol · July 2015 ER/PR/Her2 are often reflexively assessed in all core needle biopsies (CNBXs) containing invasive mammary carcinoma (IMC) so that neoadjuvant therapy can be considered. ER/PR/Her2 can be heterogenous, and there is growing consensus that negative results fo ... Full text Link to item Cite

Frozen section evaluation of breast carcinoma sentinel lymph nodes: a retrospective review of 1,940 cases.

Journal Article Breast Cancer Res Treat · November 2014 Many sentinel lymph node biopsies (SLNBs) are evaluated intraoperatively by frozen section, which may impact the need for further axillary dissection (AD). However, the need for AD in patients with small metastases has been recently called into question, m ... Full text Link to item Cite

PARP inhibitors for chemoprevention--letter.

Journal Article Cancer Prev Res (Phila) · November 2014 Full text Link to item Cite

The number of lymph nodes dissected in breast cancer patients influences the accuracy of prognosis.

Journal Article Ann Surg Oncol · February 2014 BACKGROUND: Recent trials have suggested that axillary node dissection may not be warranted in some breast cancer patients with one to two positive nodes. Given that lymph node ratio (LNR; number of positive lymph nodes divided by the total examined) has b ... Full text Link to item Cite

Is there a correlation between breast cancer molecular subtype using receptors as surrogates and mammographic appearance?

Journal Article Ann Surg Oncol · October 2013 BACKGROUND: The identification of distinct molecular subtypes has changed breast cancer management. The correlation between mammographic appearance and molecular subtype for invasive breast cancer has not been extensively studied. METHODS: A retrospective ... Full text Link to item Cite

Biomarker modulation following short-term vorinostat in women with newly diagnosed primary breast cancer.

Journal Article Clin Cancer Res · July 15, 2013 PURPOSE: Agents that target the epigenome show activity in breast cancer models. In preclinical studies, the histone deacetylase inhibitor vorinostat induces cell-cycle arrest, apoptosis, and differentiation. We evaluated biomarker modulation in breast can ... Full text Link to item Cite

Borderline atypical ductal hyperplasia/low-grade ductal carcinoma in situ on breast needle core biopsy should be managed conservatively.

Journal Article Am J Surg Pathol · June 2013 The differential diagnosis of low-nuclear grade intraductal epithelial proliferations of the breast includes atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS). This distinction can be difficult on core needle biopsy (CNB) but can have s ... Full text Link to item Cite

Does time to definitive treatment matter in patients with ductal carcinoma in situ?

Conference Am Surg · June 2013 Little is known about factors influencing time between diagnosis and definitive treatment in patients with ductal carcinoma in situ (DCIS). We sought to determine the factors influencing this delay time and implications on outcome. A retrospective review w ... Link to item Cite

Preclinical and clinical evaluation of intraductally administered agents in early breast cancer.

Journal Article Sci Transl Med · October 26, 2011 Most breast cancers originate in the epithelial cells lining the breast ducts. Intraductal administration of cancer therapeutics would lead to high drug exposure to ductal cells and eliminate preinvasive neoplasms while limiting systemic exposure. We perfo ... Full text Link to item Cite

Multiparametric magnetic resonance imaging, spectroscopy and multinuclear (²³Na) imaging monitoring of preoperative chemotherapy for locally advanced breast cancer.

Journal Article Acad Radiol · December 2010 RATIONALE AND OBJECTIVES: The aim of this prospective study was to investigate using multiparametric and multinuclear magnetic resonance imaging during preoperative systemic therapy for locally advanced breast cancer. MATERIALS AND METHODS: Women with oper ... Full text Link to item Cite

A targeted proteomics approach for biomarker discovery using bilateral matched nipple aspiration fluids

Journal Article Clinical Proteomics · September 1, 2010 Introduction: The objective of this study was to identify cancer-associated protein expression patterns in bilateral matched nipple aspiration fluids using nanoscale reciprocal Cy3/Cy5 labeling and high-content antibody microarrays. This novel platform all ... Full text Cite

A unique proteolytic fragment of alpha1-antitrypsin is elevated in ductal fluid of breast cancer patient.

Journal Article Breast Cancer Res Treat · August 2010 By comparison of mass spectra from a small cohort of nipple aspiration fluids (NAF), we previously discovered a panel of five candidate breast cancer biomarkers among them an unidentified 4.7 kD peptide BF5. The purposes of the present study were to verify ... Full text Link to item Cite

Incidental minimal atypical lobular hyperplasia on core needle biopsy: correlation with findings on follow-up excision.

Journal Article Am J Surg Pathol · June 2010 INTRODUCTION: Atypical lobular hyperplasia (ALH), often an incidental finding in breast core biopsies, is largely considered to be a risk factor for carcinoma rather than a direct precursor. However, management of ALH is controversial. We review our experi ... Full text Link to item Cite

Pathologic complete response to preoperative sequential foxorubicin/cyclophosphamide and single-agent taxane with or without trastuzumab in stage II/III HER2-positive breast cancer

Journal Article Clinical Breast Cancer · February 1, 2010 Background: Four major clinical trials have established that trastuzumab added to adjuvant systemic chemotherapy for women with HER2+ breast cancer significantly improves disease-free and overall survival compared with chemotherapy alone. We evaluated path ... Full text Cite

Feasibility trial of partial breast irradiation with concurrent dose-dense doxorubicin and cyclophosphamide in early-stage breast cancer.

Journal Article J Clin Oncol · June 10, 2009 PURPOSE: Anthracyclines and concurrent whole-breast irradiation result in prohibitive cutaneous toxicity. We hypothesized that anthracycline-based chemotherapy and concurrent partial breast irradiation (PBI) is safe and conducted a single-arm feasibility t ... Full text Link to item Cite

Nipple-sparing mastectomy: critical assessment of 51 procedures and implications for selection criteria.

Journal Article Ann Surg Oncol · December 2008 BACKGROUND: Retrospective studies have shown that occult nipple-areolar complex (NAC) involvement in breast cancer is low, occurring in 6-10% of women undergoing skin-sparing mastectomy (SSM). The cosmetic result and high patient satisfaction of nipple-spa ... Full text Link to item Cite

The superficial margin of the skin-sparing mastectomy for breast carcinoma: factors predicting involvement and efficacy of additional margin sampling.

Journal Article Ann Surg Oncol · May 2008 BACKGROUND: No study has systematically evaluated the significance of involvement of the superficial specimen margin in skin-sparing mastectomies (SSMs). METHODS: 168 SSMs with a small, additional superficial margin (ASM) specimen taken directly over the t ... Full text Link to item Cite

The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer.

Journal Article Ann Surg Oncol · February 2008 BACKGROUND: As a complement to sentinel node dissection (SLND), we evaluated ultrasound-guided fine-needle aspiration (USFNA) of normal and abnormal axillary nodes in breast cancer patients. We hypothesized that USFNA would be accurate for primary breast t ... Full text Link to item Cite

The role of breast MRI in the management of patients with breast disease.

Book · 2008 Breast MRI has paved the way for new thinking regarding the workup of women recently diagnosed with breast cancer and the screening of high-risk women. The routine use of MRI preoperatively is advocated, particularly in young patients and women with dense ... Full text Link to item Cite

Breast cancer screening and diagnosis.

Journal Article J Natl Compr Canc Netw · May 2006 Full text Link to item Cite

Breast reconstruction following subcutaneous mastectomy for cancer: a critical appraisal of the nipple-areola complex.

Journal Article Plast Reconstr Surg · April 2006 BACKGROUND: Subcutaneous mastectomy for women with advanced breast cancer has been historically controversial because of the increased risk for tumor recurrence. Despite this, some women remain interested in this method of treatment as a means of preservin ... Full text Link to item Cite

Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions.

Journal Article Am J Surg Pathol · December 2005 In breast conservation therapy, the margin status of the specimen predicts local recurrence and determines the need for reexcision. Many surgeons now take, at the time of lumpectomy, multiple separate "cavity margins" (CM) (the entire wall of the residual ... Full text Link to item Cite

Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference?

Journal Article Plast Reconstr Surg · February 2005 The advantages of breast reconstruction using the deep inferior epigastric perforator (DIEP) flap and the muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap (MS-2) are well recognized. Both techniques optimize abdominal function b ... Full text Link to item Cite

Impact of BRCA1/BRCA2 counseling and testing on newly diagnosed breast cancer patients.

Journal Article J Clin Oncol · May 15, 2004 PURPOSE: Approximately 5% to 10% of newly diagnosed breast cancer patients carry a BRCA1 or BRCA2 mutation. Given these patients' high risk for contralateral breast cancer, bilateral mastectomy is increasingly considered a treatment option for newly diagno ... Full text Link to item Cite

Radiological case of the month

Journal Article Applied Radiology · September 1, 2003 Cite

Infectious complications following breast reconstruction with expanders and implants.

Journal Article Plast Reconstr Surg · August 2003 The incidence of infection following breast reconstruction with expanders and implants ranges from 1 to 24 percent. Numerous factors associated with infection have been described; however, a one-variable at time setting and multifactorial analysis have not ... Full text Link to item Cite

Treatment of complications after breast-conservation therapy.

Journal Article Oncology (Williston Park) · August 2003 Over the past 2 decades, breast-conservation therapy with lumpectomy and whole-breast radiotherapy has become a standard option for the majority of women with newly diagnosed breast cancer. Long-term local control is achieved in approximately 85% of patien ... Link to item Cite

Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer.

Journal Article Plast Reconstr Surg · March 2003 As the inclusion criteria for breast conservation therapy have continued to evolve to include lower quadrant tumors, very large breasts, and central tumors, the potential for significant disfigurement after breast conservation therapy has also increased. T ... Full text Link to item Cite

Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care.

Journal Article J Clin Oncol · March 1, 2003 PURPOSE: There are few data on sequelae of breast cancer treatments in older women. We evaluated posttreatment quality of life and satisfaction in a national population. PATIENTS AND METHODS: Telephone surveys were conducted with a random cross-sectional s ... Full text Link to item Cite

A prospective randomized pilot study to evaluate predictors of response in serial core biopsies to single agent neoadjuvant doxorubicin or paclitaxel for patients with locally advanced breast cancer.

Journal Article Clin Cancer Res · January 2003 INTRODUCTION: Response to neoadjuvant chemotherapy for locally advanced breast cancer can be correlated with long-term outcomes. Surrogate end-point biomarkers may be used to assess response to the treatment. Most reported studies assessed the effects of c ... Link to item Cite

Sequelae of axillary lymph node dissection in older women with stage 1 and 2 breast carcinoma.

Journal Article Cancer · December 15, 2002 BACKGROUND: There are few data on the long-term sequelae of axillary dissection among older breast carcinoma patients. We describe the impact of axillary dissection in a cohort of older women. METHODS: A longitudinal cohort of 571 patients with Stage 1 and ... Full text Link to item Cite

Patient and provider characteristics that affect the use of axillary dissection in older women with stage I-II breast carcinoma.

Journal Article Cancer · May 15, 2002 BACKGROUND: Axillary dissection for the evaluation and treatment of patients with breast carcinoma often is not performed in older women. The objective of this study was to examine patient, clinical, and surgeon characteristics associated with the use of a ... Full text Link to item Cite

Development and validation of a method for using breast core needle biopsies for gene expression microarray analyses.

Journal Article Clin Cancer Res · May 2002 PURPOSE: Gene expression microarray technologies have the potential to define molecular profiles that may identify specific phenotypes(diagnosis), establish a patient's expected clinical outcome (prognosis), and indicate the likelihood of a beneficial effe ... Link to item Cite

Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer.

Journal Article Ann Surg Oncol · April 2002 BACKGROUND: After neoadjuvant chemotherapy, women with locally advanced breast cancer (LABC) undergo a modified radical mastectomy or lumpectomy with axillary lymph node dissection (ALND) and radiotherapy. Sentinel lymphadenectomy (SL) is accepted for axil ... Full text Link to item Cite

Overexpression of the glucose-regulated stress gene GRP78 in malignant but not benign human breast lesions.

Journal Article Breast Cancer Res Treat · January 2000 The 78 kDa glucose-regulated stress protein GRP78 is induced by physiological stress conditions such as hypoxia, low pH, and glucose deprivation which often exist in the microenvironments of solid tumors. Activation of this stress pathway occurs in respons ... Full text Link to item Cite

Update on treatment of early breast cancer: The trend toward less surgery, more systemic therapy

Conference Postgraduate Medicine · May 15, 1999 Each year, about 200,000 women in the United States undergo therapy for breast cancer - but are they receiving the most effective treatment? In the past, management focused on aggressive local surgery, but current strategies emphasize earlier systemic trea ... Full text Cite

Endoscopic axillary exploration and sentinel lymphadenectomy.

Journal Article Surg Endosc · January 1999 BACKGROUND: Minimally invasive approaches have changed the practice of surgery in several specialties. The purpose of this study was to develop a reproducible endoscopic technique for the evaluation of the axilla in breast cancer patients. METHODS: A total ... Full text Link to item Cite

MRI appearance of giant fibroadenoma of the breast: Overlap with phyllodes tumor

Journal Article Breast Disease · January 1, 1996 A 21-year-old woman presented with a large, well-circumscribed breast mass. Magnetic resonance imaging (MRI) showed multiple cleftlike, fluid-filled spaces within the mass, a feature described as characteristic of phyllodes tumors. Pathologic examination s ... Cite

Lobular carcinoma in situ: observation without surgery as an appropriate therapy.

Journal Article Ann Surg Oncol · March 1994 BACKGROUND: The finding of lobular carcinoma in situ (LCIS) in the breast has generally prompted treatment with unilateral or bilateral mastectomy. Most experts now feel that LCIS simply identifies a woman who is at high risk to develop future breast cance ... Full text Link to item Cite

Breast MRI as an adjunct in the diagnosis of a carcinoma partially obscured on mammography.

Journal Article Clin Imaging · 1994 The role of unenhanced breast MRI as an adjunct to mammography in the diagnosis of a breast carcinoma presenting as architectural distortion partially obscured by dense tissue on film-screen mammography is illustrated. ... Full text Link to item Cite

MRI appearance of double-lumen saline-silicone breast implants

Journal Article Breast Disease · January 1, 1994 Double-lumen saline-silicone implants have been used to decrease fibrotic capsule formation. Some of these patients are being referred for imaging evaluation complementary to mammography for suspected implant abnormalities. Magnetic resonance imaging (MRI) ... Cite

Atypical hyperplasia: frequency and mammographic and pathologic relationships in excisional biopsies guided with mammography and clinical examination.

Journal Article Radiology · December 1993 PURPOSE: To ascertain the frequency and pathologic relationships of atypical hyperplasia in biopsy specimens obtained after clinical and mammographic examination. MATERIALS AND METHODS: Clinical, mammographic, and histologic findings were prospectively cor ... Full text Link to item Cite

Breast biopsy in women 30 years old or less.

Journal Article Am J Surg · June 1993 Forty women 30 years of age or less underwent breast biopsy at Roswell Park Cancer Institute between January 1980 and January 1989. Thirty-eight of the 40 women had a palpable breast mass. Thirty-one of these young women had self-detected breast masses, an ... Full text Link to item Cite

Results of salvage mastectomy for local recurrence after breast-conserving surgery without radiation therapy.

Journal Article Cancer · March 1, 1993 BACKGROUND: Between 1975 and 1987, 128 patients with infiltrating breast cancer, categorized as clinical Stage I and II disease, were treated by breast conservation surgery without radiation therapy. MATERIALS: After a median disease-free interval of 20 mo ... Full text Link to item Cite

CT of pectoralis muscle invasion by breast carcinoma.

Journal Article J Comput Assist Tomogr · 1993 Link to item Cite

Patterns of occurrence of second primary non-mammary malignancies in breast cancer patients: results from 1382 consecutive autopsies.

Journal Article Surgical oncology · January 1993 An autopsy series on the patterns of occurrence of second primary non-mammary malignancies (SPNM) in breast cancer patients is presented. SPNM occurred in 11.4% of breast cancer patients at a mean interval of 83.9 months. Seventy-five per cent of them occu ... Full text Cite

Breast biopsy in women 30 years old or less

Journal Article American Journal of Surgery · December 1, 1992 Forty women 30 years of age or less underwent breast biopsy at Roswell Park Cancer Institute between January 1980 and January 1989. Thirty-eight of the 40 women had a palpable breast mass. Thirty-one of these young women had self-detected breast masses, an ... Cite

Flow cytometric DNA analysis of excised breast lesions: use of fresh tissue needle aspirates obtained under guidance with mammography of the specimen.

Journal Article Radiology · November 1992 Eighty consecutive biopsy specimens were studied to determine whether DNA analysis could be performed on fine-needle aspirates of excised clinically occult breast lesions obtained under guidance with mammography of the specimen before fixation to offer the ... Full text Link to item Cite

Factors affecting outcome in locally advanced breast cancer.

Journal Article Surg Oncol · October 1992 Patients presenting with locally advanced breast cancer (LABC) constitute a diverse group for which a variety of treatment modalities have been instituted. To assess which factors have a direct impact on outcome, we reviewed the medical records of 104 pati ... Full text Link to item Cite

Tumor hormone receptor status and recurrences in premenopausal patients with node-negative breast carcinoma.

Journal Article Cancer · February 15, 1992 To ascertain the prognostic significance of tumor hormone receptor status in premenopausal patients with node-negative breast cancer, a retrospective review of 199 patients who met these criteria was conducted. Of these 199 patients, estrogen receptor (ER) ... Full text Link to item Cite

Breast cancer in women under 35 years of age.

Journal Article Am J Surg · September 1991 A review was undertaken of 226 patients with primary breast carcinoma who were 35 years of age, or younger, from 1960 to 1987. Comparisons to other studies of young and older women were made for clinical, pathologic, and survival characteristics. Young pat ... Full text Link to item Cite