Our Stupendous Z-VAD-FMK Conspriracy

Although difficult to capture in a retrospective dataset, surgeons play an integral role in the surgical decision making process of the patient. Our low mastectomy rate over a 10-year period is, among other factors, likely a reflection of the (male) gender and conservative philosophy of the treating surgeon at our institution. The increased use of MRI at our institution did not seem to influence mastectomy rates, which showed a decline from 29.9% in the ��pre-MRI�� era to 24.5% in the ��MRI�� era. Patients undergoing mastectomy compared with BCS had a similar number of MRIs performed (p?=?0.1). Interestingly, however, patients undergoing mastectomy were more likely than BCS patients to have selleckchem additional findings on MRI (76% versus 39%), additional biopsies for MRI findings (45% versus 21%), and occult malignancies (31% versus 9%), which undoubtedly impacted surgical RhoC management. Without a documented rise in mastectomy rates throughout the study period, it is possible that MRI allowed for more appropriate surgical management, identifying patients requiring more extensive surgery because of multicentricity. Our findings are inconsistent with other studies which have demonstrated an increase in ��unnecessary mastectomy�� related to MRI, without improved patient selection for BCS [3, 12]. The contrary findings between this and other studies reflects the complexity of the surgical decision making process. The decision for mastectomy is multifactorial, taking into account disease extent, patient preference, surgeon bias, and treatment location. MRI alone may not explain the increased mastectomy rates reported in other series. Contralateral prophylactic mastectomy rates have significantly increased throughout the study period with 16.7% of patients in 2000 electing CPM compared with 51.9% of patients in 2010. Given the consistency in mastectomy rates in the same time period, it seems unlikely that surgeon bias is a significant contributing factor to the decision for CPM in this cohort. Several studies have demonstrated an association with Galunisertib MRI use and CPM. King et?al. demonstrated MRI at diagnosis was strongly associated with the decision for CPM (OR?=?2.79, p?