# Breast Cancer — GCMD Library living collection

Everything in the library about breast cancer — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 86 cited statements

## Episodes
### Surgical Management
- [Endoscopic nipple-sparing mastectomy: minimally invasive breast cancer surgery](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675) — podcast · 14:11 · [machine version](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675.md)

### Evidence & Research
- [BOB Ped Surg 2023 - Bernadette Jeremiasse, IPSO  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362) — video · 5:35 · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362.md)

### Emerging & Future Directions
- [Existing and Emerging Options for Pediatric Oncofertility Patients: Pediatric...](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421) — video · 49:53 · [machine version](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=0) Introduction of Dr. Teresa Woodruff and the oncofertility field (Ep 1)
- [1:45](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=105) Cancer survivorship gains and fertility threats in pediatric oncology (Ep 1)
- [9:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=560) Historical gaps in female fertility preservation and the interdisciplinary solution (Ep 1)
- [15:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=920) Professional society guidelines and the pediatric ethical framework (Ep 1)
- [19:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1180) Current clinical options: egg/embryo banking, ovarian tissue cryopreservation, and contraception counseling (Ep 1)
- [24:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1440) Ovarian tissue cryopreservation: technique and live-birth outcomes (Ep 1)
- [28:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1680) Cancer-cell contamination risk and the research imperative for in-vitro maturation (Ep 1)
- [35:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2100) Experimental advances: alginate-encapsulated IVM, zinc-spark oocyte quality assay, microfluidic 'Evatar,' and 3D-printed bioprosthetic ovaries (Ep 1)
- [39:51](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2391) Q&A: starting an oncofertility program, NPC follicle-maturation data, and patient-selection criteria (Ep 1)
- [0:12](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=12) Introduction and Clinical Problem (Ep 2)
- [1:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=90) Platform Design and Organoid Biobanks (Ep 2)
- [3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=180) Probe Selection and Imaging Methodology (Ep 2)
- [4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=240) In Vitro Screening Results and Quantification (Ep 2)
- [5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=300) In Vivo Validation and Clinical Translation (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=0) Introduction and Background (Ep 3)
- [1:23](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=83) Technique Overview and Evolution from Conventional Surgery (Ep 3)
- [3:17](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=197) Reconstruction and Collaboration with Plastic Surgery (Ep 3)
- [4:01](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=241) Historical Development and Current Adoption (Ep 3)
- [6:00](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=360) Comparison with Robotic Surgery (Ep 3)
- [7:19](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=439) Patient and Tumor Selection Criteria (Ep 3)
- [9:11](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=551) Patient Benefits and Oncologic Safety (Ep 3)
- [11:18](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=678) Insurance Coverage and Future Directions (Ep 3)
- [13:11](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=791) Closing Remarks and Adoption Outlook (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In the United States, approximately 85% of pediatric cancer patients now survive their initial disease, up from much lower rates in the 1970s, due to earlier diagnostics, improved chemotherapy, biologics, and changes in radiation. — Teresa Woodruff (epidemiological) [Ep 1 · 1:45](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=105)
- Approximately 1.4–1.5 million people are newly diagnosed with cancer annually in the US; globally there are ~10 million new cases per year. About 10% of US cases occur in patients aged ≤45, and 11% of breast cancers are diagnosed before age 40, totaling roughly 200,000 young patients annually. — Teresa Woodruff (epidemiological) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=180)
- Pediatric cancer survivors are significantly more likely to be infertile than their siblings. — Teresa Woodruff (epidemiological) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=340)
- Fertility concerns extend beyond cancer to rheumatologic diseases (often female, treated with cytotoxic drugs), beta-thalassemia patients receiving stem-cell transplant with sterilizing whole-body radiation, Turner syndrome (mosaic cases with early ovarian failure), BRCA or other cancer-predisposition mutations, and disorders of sex development or gender transition where the biological gamete may be at risk. — Teresa Woodruff (clinical) [Ep 1 · 6:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=360)
- Sperm banking has been available for pubertal boys and men for many years at relatively low cost, but navigation to these services was historically poor. — Teresa Woodruff (clinical) [Ep 1 · 8:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=500)
- Young women historically had fewer fertility-preservation options than men due to three gaps: information (providers unaware of long-term infertility risk), data (inability to predict individual outcomes), and options (lack of techniques for prepubertal or young patients). — Teresa Woodruff (clinical) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=540)
- It remains difficult to predict on an individual basis which patients will recover gonadal function after gonadotoxic treatment and which will be permanently sterile. — Teresa Woodruff (clinical) [Ep 1 · 10:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=620)
- The Oncofertility Consortium adopted an interdisciplinary framework requiring investment in basic follicle biology, creation of 'silo spanners' (patient navigators bridging oncology, reproductive endocrinology, surgery, genetics, and radiation oncology), training of new scholars in interdisciplinary thinking, and 360° patient support (legal, ethical, insurance, religious counseling). — Teresa Woodruff (clinical) [Ep 1 · 11:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=660)
- For women aged ≥18, embryo or egg banking is an established option; the Oncofertility Consortium lowered the recommended age threshold from 18 to 16 two years ago, but use below age 16 should occur only under IRB approval. — Teresa Woodruff (clinical) [Ep 1 · 17:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1060)
- Across Oncofertility Consortium sites, the average wait time for controlled ovarian stimulation and egg retrieval is 12 days. — Teresa Woodruff (clinical) [Ep 1 · 19:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1180)
- Tamoxifen holidays allow hormone-receptor-positive breast cancer survivors to become pregnant with good outcomes and may improve long-term compliance with adjuvant endocrine therapy. — Teresa Woodruff (clinical) [Ep 1 · 20:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1200)
- For prepubertal and adolescent patients up to age 16, ovarian tissue cryopreservation (removal of an entire ovary or cortical biopsy under IRB-approved consent) is the only available fertility-preservation option. — Teresa Woodruff (clinical) [Ep 1 · 20:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1240)
- Ovarian cortical tissue is dissected into small strips containing primordial through antral follicles and cryopreserved; tissue may need to remain frozen for 20–30 years if the patient is 5 or 6 years old at diagnosis. — Teresa Woodruff (clinical) [Ep 1 · 21:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1300)
- Oocytes that are released adventitiously during ovarian-tissue dissection are often allocated to research in pediatric cases (rather than cryopreserved for the patient) because oocyte quality and aneuploidy rates in patients under 18 are not well characterized; aneuploidy is known to rise both above age 35 and below age 18. — Teresa Woodruff (clinical) [Ep 1 · 22:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1360)
- Eighty-six live human births have been documented worldwide from autotransplantation of cryopreserved ovarian tissue, demonstrating that current cryopreservation methods maintain tissue function. — Teresa Woodruff (clinical) [Ep 1 · 25:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1500)
- The denominator for ovarian-tissue transplants (total number attempted) and cancer-recurrence rates are not known globally, limiting assessment of efficacy and safety. — Teresa Woodruff (clinical) [Ep 1 · 25:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1540)
- Pediatric ovarian cortex contains more primordial follicles than adult tissue (follicles are formed in utero between the second and third trimester), but may also harbor circulating cancer cells; transplanting such tissue risks reintroducing malignancy. — Teresa Woodruff (clinical) [Ep 1 · 27:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1620)
- Histologic staining of a 4-year-old patient's ovarian cortex revealed both abundant primordial follicles and circulating cancer cells, illustrating the contamination risk. — Teresa Woodruff (clinical) [Ep 1 · 28:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1700)
- Follicles cultured on flat plastic do not maintain three-dimensional architecture; mouse follicles form follicle-like structures but oocytes mature poorly, and human follicles simply flatten out. — Teresa Woodruff (clinical) [Ep 1 · 31:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1860)
- Encapsulating isolated follicles in alginate hydrogel maintains three-dimensional architecture, permits follicle expansion and granulosa-cell differentiation into theca cells, and supports estrogen production over time in both mouse and human follicles. — Teresa Woodruff (clinical) [Ep 1 · 32:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1920)
- Alginate-encapsulated mouse follicles undergo in-vitro ovulation (antrum formation, oocyte migration to one pole, rupture, and cumulus–oocyte-complex release) and yield live healthy mouse pups after fertilization. — Teresa Woodruff (clinical) [Ep 1 · 33:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2000)
- A microfluidic 'organ-on-chip' system (Evatar) linking mouse ovary with human fallopian tube, uterus, cervix, and liver has reproduced a full 28-day menstrual cycle in vitro, including follicular-phase estradiol rise, mid-cycle HCG-triggered ovulation, and luteal-phase progesterone, and can model early pregnancy by maintaining progesterone. — Teresa Woodruff (clinical) [Ep 1 · 34:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2060)
- Human ovarian follicles have been grown in alginate for 30–40 days; after 40 days, germinal-vesicle-intact oocytes can be recovered and matured in vitro. — Teresa Woodruff (clinical) [Ep 1 · 36:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2160)
- In 2015, Woodruff's group reported the first human metaphase-II eggs matured entirely in vitro from encapsulated follicles, a milestone for fertility preservation without tissue transplantation. — Teresa Woodruff (clinical) [Ep 1 · 36:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2200)
- Mature human and mouse oocytes release a 'zinc spark'—a burst of zinc fluorescence—at fertilization; immature oocytes do not. This assay may serve as a non-invasive marker of oocyte developmental competence. — Teresa Woodruff (clinical) [Ep 1 · 37:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2240)
- Decellularized ovarian scaffolds ('ovary paper') can be repopulated with follicles and sutured to soft tissue; when transplanted into ovariectomized prepubertal mice, 100% of recipients underwent puberty. — Teresa Woodruff (clinical) [Ep 1 · 38:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2300)
- Three-dimensional-printed gelatin scaffolds seeded with GFP-labeled prepubertal mouse follicles become vascularized after transplant and yield live GFP-positive pups, representing the first soft-organ transplant with fully 3D-printed bio-inspired tissue. — Teresa Woodruff (clinical) [Ep 1 · 39:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2360)
- Woodruff's group is translating bioprosthetic ovary work to minipigs and plans to transplant small scaffold pieces subcutaneously in consenting human recipients to assess biocompatibility. — Teresa Woodruff (clinical) [Ep 1 · 40:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2420)
- Dr. Soo Yung Kim is developing next-generation neoadjuvant fertoprotective drugs with the goal of eliminating the need for ovarian-tissue removal in future cancer patients. — Teresa Woodruff (clinical) [Ep 1 · 41:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2460)
- In a one-year National Physicians Cooperative study, 44 pediatric patients (ages 1 month to 15 years) contributed fresh (not cryopreserved) ovarian tissue; 44 follicles were isolated, approximately 20 formed antra, and 4 yielded metaphase-II eggs (the remainder were germinal-vesicle stage). Results were published in Scientific Reports 2015. — Teresa Woodruff (clinical) [Ep 1 · 43:03](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2583)
- A 2016 analysis of NPC pediatric cases (ICD-10 codes) confirmed that clinicians appropriately selected patients at high risk for gonadotoxicity; this work was presented at the 2016 Oncofertility meeting and is pending publication. — Teresa Woodruff (clinical) [Ep 1 · 45:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2720)
- For males, sperm banking is recommended regardless of risk level if the family is concerned, because it is non-operative and relatively inexpensive (though it costs money and ~6 hours). For females, ovarian-tissue cryopreservation is a surgical intervention and should be reserved for high-risk cases identified by oncologists using established criteria. — Teresa Woodruff (opinion) [Ep 1 · 46:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2800)
- At the beginning of the Oncofertility Consortium, all tissue-banking cases were adults with breast cancer; today nearly no adults participate in the NPC tissue program because they have other options (egg/embryo banking), and the program focuses on pediatric patients. — Teresa Woodruff (clinical) [Ep 1 · 48:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=2880)
- Achieving complete tumor resections without major complications remains challenging because some tumors are difficult to distinguish from healthy tissue and in other tumors the margin is very narrow. — Bernadette Jeremiasse (clinical) [Ep 2 · 0:12](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=12)
- Fluorescence guided surgery with tumor-specific probes can visually assist the surgeon in discriminating tumors from healthy tissue. — Bernadette Jeremiasse (clinical) [Ep 2 · 0:50](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=50)
- Tumor-specific probes are currently screened one by one and per tumor type. — Bernadette Jeremiasse (clinical) [Ep 2 · 1:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=70)
- The imaging platform combines tumor organoid biobanks with 3D live imaging and is able to screen fluorescent guided surgery probes in a tumor-specific and patient-specific way. — Bernadette Jeremiasse (clinical) [Ep 2 · 1:25](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=85)
- Organoids maintain molecular tumor characteristics and can be held in culture for a long time. — Bernadette Jeremiasse (clinical) [Ep 2 · 1:50](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=110)
- The platform uses both adult and pediatric tumor organoid biobanks, specifically neuroblastoma and breast cancer. — Bernadette Jeremiasse (clinical) [Ep 2 · 2:05](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=125)
- Control organoids were chosen based on the tissue surrounding the tumor: kidney organoids for neuroblastoma and healthy breast organoids for breast cancer. — Bernadette Jeremiasse (clinical) [Ep 2 · 2:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=140)
- Surface markers upregulated in neuroblastoma or breast cancer were identified based on RNA profiling, the human protein atlas, and literature review. — Bernadette Jeremiasse (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=180)
- Probes targeting surface markers were conjugated to six different fluorophores ranging between 488 and 647 nanometers. — Bernadette Jeremiasse (clinical) [Ep 2 · 3:20](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=200)
- Seven-colored 3D live imaging using confocal microscopy on living organoids was performed, including six probe fluorophores plus the general marker eFluor. — Bernadette Jeremiasse (clinical) [Ep 2 · 3:35](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=215)
- Segmentation analysis was performed using the STAPLE pipeline developed in the laboratory, and fluorescent signals were quantified. — Bernadette Jeremiasse (clinical) [Ep 2 · 3:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=235)
- The three most promising probes for neuroblastoma were validated in vivo using a mouse xenograft model with tumors originating from neuroblastoma organoids. — Bernadette Jeremiasse (clinical) [Ep 2 · 4:10](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=250)
- Probe fluorescence varies between patients and even within a patient in neuroblastoma organoid lines. — Bernadette Jeremiasse (clinical) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=280)
- Different probes work on tumor organoids compared to healthy control organoids. — Bernadette Jeremiasse (clinical) [Ep 2 · 4:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=295)
- The STAPLE pipeline performs 3D segmentation by first segmenting membrane and nuclear signals, generating cells, and combining cells to form single organoids. — Bernadette Jeremiasse (clinical) [Ep 2 · 5:05](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=305)
- An organoid is determined to be positive when the intensity of the tumor organoid is at least twice the fluorescence of the healthy control organoid. — Bernadette Jeremiasse (clinical) [Ep 2 · 5:25](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=325)
- Thousands of organoids were quantified using this methodology. — Bernadette Jeremiasse (clinical) [Ep 2 · 5:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=345)
- Four markers showed promise for neuroblastoma based on high percentages of positive organoids and high fluorescent intensities. — Bernadette Jeremiasse (clinical) [Ep 2 · 5:55](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=355)
- The platform can predict which combinations of probes are most promising by screening six probes simultaneously. — Bernadette Jeremiasse (clinical) [Ep 2 · 6:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=375)
- The three most promising probes tested in vivo for neuroblastoma were GD2, L1CAM, and NCAM. — Bernadette Jeremiasse (clinical) [Ep 2 · 6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=390)
- These three probes resulted in tumor-to-background ratios above 2, indicating good intraoperative visibility. — Bernadette Jeremiasse (clinical) [Ep 2 · 6:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=405)
- In vitro imaging patterns resemble the efficacy in vivo, with L1CAM showing higher signal than GD2 in both settings. — Bernadette Jeremiasse (clinical) [Ep 2 · 7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=420)
- The order of neuroblastoma organoid line performance was similar in vitro and in vivo, with line 129 being highest and line 67 being lowest. — Bernadette Jeremiasse (clinical) [Ep 2 · 5:35](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=335)
- One of the tested probes is advancing to a clinical trial this year. — Bernadette Jeremiasse (clinical) [Ep 2 · 5:35](https://library.globalcastmd.com/watch/bob-ped-surg-2023-bernadette-jeremiasse-ipso-presentation-6362?t=335)
- 1999 was the first nipple-sparing mastectomy reported. — Paula Escobar (clinical) [Ep 3 · 1:26](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=86)
- Dr. Crowe at Cleveland Clinic was one of the pioneers who developed the open/conventional nipple-sparing mastectomy technique. — Paula Escobar (clinical) [Ep 3 · 1:32](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=92)
- Endoscopic nipple-sparing mastectomy uses the same technique as conventional nipple-sparing mastectomy but with different tools (minimally invasive approach with less scarring). — Paula Escobar (clinical) [Ep 3 · 1:53](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=113)
- The incision is placed in the mid-axillary line hidden by the arm or in the submammary fold, making it completely invisible. — Paula Escobar (clinical) [Ep 3 · 2:35](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=155)
- The procedure involves inflating/expanding the breast with CO2, then introducing laparoscopic instruments through a single incision to remove breast tissue while preserving the envelope. — Paula Escobar (clinical) [Ep 3 · 2:49](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=169)
- Immediate breast reconstruction is attempted at the time of mastectomy, with plastic surgeons adjusting their technique to work through the smaller incision. — Paula Escobar (clinical) [Ep 3 · 3:28](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=208)
- The current endoscopic technique has approximately 5 years of history in its present form. — Paula Escobar (clinical) [Ep 3 · 4:07](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=247)
- Minimally invasive breast surgery started in Asian countries approximately 20 years ago using mechanical arms to lift the breast, but early attempts had complications in skin flaps and nipples due to limited technology. — Paula Escobar (clinical) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=250)
- The technique developed in Europe (France, Spain, Italy) using CO2 insufflation and is now being learned in the US. — Paula Escobar (clinical) [Ep 3 · 4:35](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=275)
- Very few surgeons in the US currently perform endoscopic nipple-sparing mastectomy, making it difficult for patients to access. — Paula Escobar (epidemiological) [Ep 3 · 5:10](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=310)
- Three hands-on simulated model courses have been held in the US to train surgeons in the technique. — Paula Escobar (clinical) [Ep 3 · 5:23](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=323)
- Cleveland Clinic has trained multiple surgeons in the endoscopic technique, with Dr. Escobar helping to train colleagues. — Paula Escobar (clinical) [Ep 3 · 5:47](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=347)
- Robotic breast surgery takes a long time, requires a robot, has a long learning curve, and is not FDA approved (currently only available in trials at limited US centers). — Paula Escobar (clinical) [Ep 3 · 6:16](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=376)
- Endoscopic surgery uses instruments already available for abdominal/hernia surgery, requiring no special equipment purchases. — Paula Escobar (clinical) [Ep 3 · 6:36](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=396)
- Operating time for endoscopic surgery, when experienced, is similar to open/conventional surgery. — Paula Escobar (clinical) [Ep 3 · 7:04](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=424)
- Indications for endoscopic nipple-sparing mastectomy are very similar to conventional nipple-sparing mastectomy. — Paula Escobar (clinical) [Ep 3 · 7:40](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=460)
- Patients are not good candidates if tumor involves the skin, is very close to the muscle, is very close to the nipple, or involves the skin. — Paula Escobar (clinical) [Ep 3 · 7:46](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=466)
- Best candidates have cup A, B, or C breasts (not larger breasts at current learning curve stage). — Paula Escobar (clinical) [Ep 3 · 8:45](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=525)
- Procedure is performed on patients with no ptosis or ptosis grade 1 or 2, as higher grades result in poor cosmetic outcomes. — Paula Escobar (clinical) [Ep 3 · 8:59](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=539)
- Patient advantages include superior cosmetic outcome, hidden/invisible scar, and likely quicker recovery with less pain (similar to laparoscopic vs open abdominal surgery). — Paula Escobar (clinical) [Ep 3 · 9:26](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=566)
- Preliminary studies suggest patients have better sensation in the nipple and mastectomy skin flap, though quality trials are needed. — Paula Escobar (clinical) [Ep 3 · 9:51](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=591)
- Initial patients have been very happy with the procedure and recovered very quickly. — Paula Escobar (clinical) [Ep 3 · 10:09](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=609)
- Oncological safety of conventional nipple-sparing mastectomy has been proven by data. — Paula Escobar (clinical) [Ep 3 · 10:26](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=626)
- Endoscopic technique may be better than conventional because the magnified screen visualization allows better handling of the mastectomy skin flap and improved visualization of breast tissue behind the nipple and axillary tail. — Paula Escobar (opinion) [Ep 3 · 10:41](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=641)
- No insurance coverage problems have occurred; procedure is coded as skin-sparing mastectomy since no specific code exists yet. — Paula Escobar (clinical) [Ep 3 · 11:34](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=694)
- Cleveland Clinic has performed endoscopic nipple-sparing mastectomy with endoscopically-assisted sentinel node retrieval through a single incision. — Paula Escobar (clinical) [Ep 3 · 11:56](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=716)
- Future applications include axillary dissection and lumpectomy for tumors in inner portions of the breast (scar in axilla instead of breast). — Paula Escobar (clinical) [Ep 3 · 12:12](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=732)
- The technique has been used for gynecomastia surgery in one male patient. — Paula Escobar (clinical) [Ep 3 · 12:24](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=744)
- Dr. Escobar predicts widespread adoption will occur similar to laparoscopic cholecystectomy, driven by patient experience, outcomes, and faster recovery. — Paula Escobar (opinion) [Ep 3 · 12:49](https://library.globalcastmd.com/watch/endoscopic-nipple-sparing-mastectomy-minimally-invasive-breast-cancer-surgery-13675?t=769)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Chemotherapy and/or hormone therapy for breast cancer significantly lower the age of menopause compared to untreated controls (median ~51.5 years); combination therapy produces the earliest menopause. — Teresa Woodruff summarizing a resource [Ep 1 · 4:00](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=240)
- Since 2010, ASCO, ASRM, and the Pediatric Hematology/Oncology Nursing Society have published practice guidelines mandating that providers discuss fertility impairment at the earliest possible moment, refer to a qualified oncofertility specialist, and promote ongoing research. — Teresa Woodruff summarizing a resource [Ep 1 · 15:20](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=920)
- The American Academy of Pediatrics has provided guidance that parents may act to preserve the fertility of pediatric cancer patients, an important ethical advance because fertility is not impaired at the time of diagnosis. — Teresa Woodruff summarizing a resource [Ep 1 · 16:40](https://library.globalcastmd.com/watch/existing-and-emerging-options-for-pediatric-oncofertility-patients-pediatric-421?t=1000)

## Changelog
- Oct 5: 3 items added automatically

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