Karen L Hiotis, M.D.

Cervical adenocarcinoma in a patient with lynch syndrome, Muir-Torre variant
Nair N.; Curtin J.P.; Mittal K.; Hiotis K.L.
2012 ;30(2):e5-e6, Journal of clinical oncology
— id: 149969, year: 2012, vol: 30, page: e5, stat: Journal Article,

A tracking and feedback registry to reduce racial disparities in breast cancer care
Bickell, Nina A; Shastri, Kruti; Fei, Kezhen; Oluwole, Soji; Godfrey, Henry; Hiotis, Karen; Srinivasan, Anitha; Guth, Amber A
2008 Dec 3;100(23):1717-1723, Journal of the National Cancer Institute
BACKGROUND: Black and Hispanic women with early-stage breast cancer are more likely than white women to experience fragmented care and less likely to see medical oncologists to get effective adjuvant treatment. We implemented a tracking and feedback registry to close the referral loop between surgeons and oncologists. METHODS: We compared completed oncology consultations and use of adjuvant treatment among a group of 639 women with newly diagnosed stage I or II breast cancer who had undergone surgery at one of six New York City hospitals from 1999 to 2000 with the same outcomes for a different group of 300 women with breast cancer whose surgeries occurred in 2004-2006, after the implementation of the tracking registry. Underuse of adjuvant treatment was defined as no radiotherapy after breast-conserving surgery, no chemotherapy for estrogen receptor (ER)-negative tumors, or no hormonal therapy for ER-positive tumors 1 cm or larger. We used hierarchical modeling to adjust for clustering within hospital and surgeon practice. Odds ratios were converted to adjusted relative risks (aRRs). All statistical tests were two-sided. RESULTS: Implementation of the tracking and feedback registry was accompanied by a statistically significant increase in oncology consultations (83% before vs 97% after the intervention; difference = 14%; 95% confidence interval [CI] = 11% to 18%; P < .001) and decrease in underuse of adjuvant treatment (23% before vs 14% after the intervention; difference = -9%, 95% CI = -12% to -6%; P < .001). Underuse declined from 34% to 14% among black women, from 23% to 13% among Hispanic women, and from 17% to 14% among white women (chi-square of change in underuse from before to after among the three racial groups; P = .001). In multivariable models adjusting for clustering by hospital and surgeon, the intervention was associated with increased rates of oncology consultation (aRR = 1.6, 95% CI = 1.3 to 1.8), and reduced underuse of adjuvant treatment (aRR = 0.75, 95% CI = 0.6 to 0.9). Compared with the preintervention findings, minority race was no longer a risk factor for low rates of oncology consultation (aRR = 1.0, 95% CI = 0.7 to 1.3) or for underuse of adjuvant therapy (aRR = 1.0, 95% CI = 0.8 to 1.3). CONCLUSIONS: A tracking and feedback registry that enhances completed oncology consultations between surgeons and oncologists also appears to reduce rates of adjuvant treatment underuse and to eliminate the racial disparity in treatment
— id: 96570, year: 2008, vol: 100, page: 1717, stat: Journal Article,

A decade of change : an institutional experience with breast surgery in 1995 and 2005
Guth AA; Shanker BA; Roses DF; Axelrod D; Singh B; Toth H; Shapiro RL; Hiotis K; Diflo T; Cangiarella JF
2008 ;1:51-55, Breast cancer : basic & clinical research
— id: 93532, year: 2008, vol: 1, page: 51, stat: Journal Article,

A decade of change: an institutional experience with breast surgery in 1995 and 2005
Guth, Amber A; Shanker, Beth Ann; Roses, Daniel F; Axelrod, Deborah; Singh, Baljit; Toth, Hildegard; Shapiro, Richard L; Hiotis, Karen; Diflo, Thomas; Cangiarella, Joan F
2008 ;1:51-55, Breast cancer : basic & clinical research
INTRODUCTION: With the adoption of routine screening mammography, breast cancers are being diagnosed at earlier stages, with DCIS now accouting for 22.5% of all newly diagnosed breast cancers. This has been attributed to both increased breast cancer awareness and improvements in breast imaging techniques. How have these changes, including the increased use of image-guided sampling techniques, influenced the clinical practice of breast surgery? METHODS: The institutional pathology database was queried for all breast surgeries, including breast reconstruction, performed in 1995 and 2005. Cosmetic procedures were excluded. The results were analysed utilizing the Chi-square test. RESULTS: Surgical indications changed during 10-year study period, with an increase in preoperatively diagnosed cancers undergoing definitive surgical management. ADH, and to a lesser extent, ALH, became indications for surgical excision. Fewer surgical biopsies were performed for indeterminate abnormalities on breast imaging, due to the introduction of stereotactic large core biopsy. While the rate of benign breast biopsies remained constant, there was a higher percentage of precancerous and DCIS cases in 2005. The overall rate of mastectomy decreased from 36.8% in 1995 to 14.5% in 2005. With the increase in sentinel node procedures, the rate of ALND dropped from 18.3% to 13.7%. Accompanying the increased recognition of early-stage cancers, the rate of positive ALND also decreased, from 43.3% to 25.0%. CONCLUSIONS: While the rate of benign breast biopsies has remained constant over a recent 10-year period, fewer diagnostic surgical image-guided biopsies were performed in 2005. A greater percentage of patients with breast cancer or preinvasive disease have these diagnoses determined before surgery. More preinvasive and Stage 0 cancers are undergoing surgical management. Earlier stage invasive cancers are being detected, reflected by the lower incidence of axillary nodal metastases
— id: 149787, year: 2008, vol: 1, page: 51, stat: Journal Article,

Receptor status and ethnicity of indigent patients with breast cancer in New York City
Marti, Jennifer L; Guth, Amber; Naik, Arpana; Hiotis, Karen L
2008 Dec;143(12):1227-1230, Archives of Surgery (Chicago)
Previous studies have suggested racial differences in breast cancer hormonal receptor status, reflecting possible differences in tumor biology. However, racial differences in socioeconomic status and reproductive risk factors may influence receptor status. We investigated this issue, studying a racially diverse but socioeconomically homogeneous cohort of 215 patients with breast cancer at a New York public hospital from January 1, 1999, through December 31, 2003. We analyzed positive findings for estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) (HER2/neu) receptors, considering patients in racial groups by cancer stage and overall. No difference was found in rates of estrogen, progesterone, or HER2/neu positivity among Asian, black, Hispanic, or white patients presenting with ductal carcinoma in situ or with invasive cancer
— id: 91464, year: 2008, vol: 143, page: 1227, stat: Journal Article,

Surgical images: soft tissue. Necrotizing fasciitis of the abdominal wall
Miller, George; MacLean, Alexandra A; Hiotis, Karen
2008 Feb;51(1):56-56, Canadian journal of surgery = Journal canadien de chirurgie
— id: 76863, year: 2008, vol: 51, page: 56, stat: Journal Article,

Breast reconstruction in a university-based public hospital
Levine, SM; Vaksman, A; Hiotis, K; Levine, JP
2007 DEC ;106(1):S76-S77, Breast cancer research & treatment
— id: 75802, year: 2007, vol: 106, page: S76, stat: Journal Article,

Missed opportunities: racial disparities in adjuvant breast cancer treatment
Bickell, Nina A; Wang, Jason J; Oluwole, Soji; Schrag, Deborah; Godfrey, Henry; Hiotis, Karen; Mendez, Jane; Guth, Amber A
2006 Mar 20;24(9):1357-1362, Journal of clinical oncology
PURPOSE: Underuse of adjuvant therapy is a potentially important and remediable explanation for the inferior survival of minority women with breast cancer. We sought to measure a racial disparity in the underuse of adjuvant treatments for early-stage breast cancer and to identify associated factors. METHODS: Cross-sectional study with review of all inpatient and outpatient medical records of 677 women treated surgically for a primary American Joint Committee on Cancer stage I or II breast cancer in 1999 to 2000. Underuse was defined as omissions of radiation therapy after breast-conserving surgery, adjuvant chemotherapy after resection of hormone-receptor-negative tumors > or = 1 cm, or hormonal therapy for receptor-positive tumors > or = 1 cm. RESULTS: One hundred forty-five (21%) of 677 women experienced underuse of appropriate adjuvant therapy: 16% in whites, 34% in blacks, and 23% in Hispanics (P < .001). Women referred to medical oncologists were less likely to experience underuse of necessary adjuvant treatments (relative risk [RR] for underuse = 0.2; 95% CI, 0.1 to 0.3). Women who were minorities (RR = 2.0; 95% CI, 1.3 to 3.1), had higher levels of comorbidity (RR = 1.4; 95% CI, 1.1 to 1.8) and lacked insurance (RR = 1.9; 95% CI, 0.9 to 4.0) were at greater risk for underuse. CONCLUSION: Minority women with early-stage breast cancer have double the risk of white women for failing to receive necessary adjuvant treatments despite rates of oncologic consultation similar to those for white women. Oncology referrals are necessary to reduce treatment disparities but are not sufficient to ensure patients' receipt of efficacious adjuvant treatment
— id: 96571, year: 2006, vol: 24, page: 1357, stat: Journal Article,

Intramammary lymph nodes and breast cancer: a marker for disease severity, or just another lymph node?
Guth, Amber A; Mercado, Cecilia; Roses, Daniel F; Hiotis, Karen; Skinner, Kristin; Diflo, Thomas; Cangiarella, Joan
2006 Oct;192(4):502-505, American journal of surgery
BACKGROUND: Axillary lymph node status is still considered the most significant prognostic factor for breast cancer outcome, and treatment decisions are based on the presence or absence of nodal disease. Intramammary lymph nodes (IMLNs) can be a site of regional spread. Is this a marker for more aggressive disease? METHODS: We reviewed the cancer center pathology database from 1991 to 2005 for all cases of breast cancer with IMLNs. RESULTS: IMLNs were identified in 64 breast cancer patients, with metastatic spread in 20 patients, and benign IMLNs described in 44 patients. Positive IMLNs were associated with more aggressive disease, including higher rates of invasive versus noninvasive cancers (5% ductal carcinoma-in-situ [DCIS] with positive IMLNs vs. 23% with negative IMLNs), lymphovascular invasion (55% vs. 11%), and a higher rate of axillary lymph node involvement (72% vs. 18%). Patients with positive IMLNs were also more likely to undergo mastectomy (75% vs. 54%). CONCLUSIONS: IMLN metastases are a marker for disease severity; recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLN is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection. Preoperative lymphoscintigraphy may help identify these extra-axillary metastases
— id: 69076, year: 2006, vol: 192, page: 502, stat: Journal Article,

Breast cancer detection in a minority population: Can we succeed in early diagnosis?
Hiotis, KL; Marti, JL; Harris, MA; Naik, A; Shapiro, RL; Guth, AA
2006 MAY ;15(4):471-471, Journal of women's health (Larchmont, N.Y. : 2002)
— id: 64631, year: 2006, vol: 15, page: 471, stat: Journal Article,

Influence of gender on surgical outcomes: does gender really matter?
Guth, Amber A; Hiotis, Karen; Rockman, Caron
2005 Mar;200(3):440-455, Journal of the American College of Surgeons
— id: 50294, year: 2005, vol: 200, page: 440, stat: Journal Article,

The importance of location in determining breast conservation rates
Hiotis, Karen; Ye, Wei; Sposto, Richard; Goldberg, Judith; Mukhi, Vandana; Skinner, Kristin
2005 Jul;190(1):18-22, American journal of surgery
BACKGROUND: This study evaluates differences in the utilization of breast conservation surgery (BCS) between major metropolitan areas in the United States (US) and the United Kingdom (UK). METHODS: Surgical and staging information were obtained from the Cancer Surveillance Program for Los Angeles County (LAC), the New York State (NYS) Department of Health Cancer Registry, and the UK National Health Service (NHS) Breast Screening Program. Demographic data were obtained from the census databases from the US, UK, Northern Ireland, and Scotland. Descriptive statistics, correlation analysis, and chi-square tests were used to compare rates of BCS across the locations under study. RESULTS: Breast conservation rates were highest in London (79.3%) compared to New York City (NYC) (69.7%) and LAC (66.5%) (P < .0001). Both in NYS and the UK, the cities differ from the surrounding regions in population density, education levels, agricultural activities, and unemployment. BCS rates tended to increase with population density and education levels, and decrease with increased unemployment and agricultural activity, but there was no impact on BCS rates when adjustments for these variables were included in regression models. BCS rates increase with increasing hospital case volume in LAC and NYC (P < .0001). CONCLUSION: When comparing large metropolitan areas in the US and UK there are significantly different rates of BCS in different locations. These differences reflect differences in population density, socioeconomic status (SES), education levels, hospital volume, and the effects of a nationally funded screening program
— id: 71025, year: 2005, vol: 190, page: 18, stat: Journal Article,

Predictors of breast conservation therapy: size is not all that matters
Hiotis, Karen; Ye, Wei; Sposto, Richard; Skinner, Kristin A
2005 Mar 1;103(5):892-899, Cancer
BACKGROUND: Despite the National Institutes of Health consensus statement in 1991 that breast-conserving surgery (BCS) followed by radiotherapy is an appropriate approach to the treatment of early-stage breast carcinoma, studies have shown a relatively low rate of BCS in the United States. The current study investigated predictors of breast conservation therapy in a large, diverse patient population. METHODS: Between 1990 and 1998, 43,111 patients underwent surgery for breast carcinoma and were entered into the Cancer Surveillance Program database for Los Angeles County. Of these, 29,666 (68.3%) had complete data on patient demographics, staging, surgeon, type of surgery, and hospital. Data were collected regarding extent of disease, lymph node status, tumor size, age, race, socioeconomic status (SES), surgeon specialization, surgeon volume, hospital specialization, and hospital volume. Univariate and multivariate analyses were performed. RESULTS: Univariate analysis showed that extent of disease, lymph node status, tumor size, age, race, SES, surgeon and hospital specialization, and surgeon and hospital volume all were significantly associated with surgery type (P <0.0001). Multivariate analysis showed that not only did extent of disease impact choice of surgery, but so did race, SES, hospital volume, surgeon volume, and surgeon specialization (P <0.0001). CONCLUSIONS: These results suggest that not only does the extent of locoregional disease play a role in the likelihood of a woman undergoing breast conservation therapy, but patient age, socioeconomic status, racial/ethnic factors, and the experience of both the surgeon and hospital have an effect
— id: 50287, year: 2005, vol: 103, page: 892, stat: Journal Article,

Abdominal wall necrotizing fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: a case series
MacLean, Alexandra A; Miller, George; Bamboat, Zubin M; Hiotis, Karen
2004 Sep;70(9):827-831, American surgeon
We report three cases of abdominal wall necrotizing fasciitis that occurred as a result of leakage from displaced percutaneous endoscopic gastrostomy tubes. This is the first report of such a series. Patients underwent extensive operative excisions of their abdominal walls down to their posterior fascia. All patients tolerated their initial surgery, however, two patients ultimately expired from respiratory complications. The surviving patient underwent multiple repeat debridements and reconstructive abdominal wall surgery. We review the epidemiology of patients at risk for this complication and discuss its presentation, as well as the appropriate workup and management. We also address the issues of closure of large abdominal wall defects and future alimentation in this patient group. Finally, abdominal wall necrotizing faciitis from gastrostomy tube leakage is a devastating complication, and the development of preventative strategies for patients at risk is of paramount importance
— id: 47840, year: 2004, vol: 70, page: 827, stat: Journal Article,

Colocolonic intussusception of a giant pseudopolyp in a patient with ulcerative colitis: a case report and review of the literature
Maldonado, Thomas S; Firoozi, Babak; Stone, David; Hiotis, Karen
2004 Jan;10(1):41-44, Inflammatory bowel diseases
Adult intussusception in the setting of inflammatory bowel disease (IBD) is a rare phenomenon. Giant pseudopolyps, while generally considered benign, may function as lead points for intussusception. Diagnosis and management of intussusception in the setting of IBD can be fraught with hazards. We report the case of a 27-year-old male, recently diagnosed with ulcerative colitis and giant pseudopolyps, who presented with colocolonic intussusception and obstruction. Diagnosis was confirmed using CT imaging and the patient underwent resection of the colocolonic intussusception without reduction. The following case underscores the challenges in managing adult intussusception in the setting of IBD and allows for a review of the literature to date. Resection of non-reduced intussusception, rather than endoscopic or enema reduction, should continue to be definitive treatment of patients presenting with this unusual problem
— id: 42876, year: 2004, vol: 10, page: 41, stat: Journal Article,

Leiomyosarcoma of the breast: A difficult diagnosis on fine-needle aspiration biopsy
Jun Wei, Xiao; Hiotis, Karen; Garcia, Roberto; Hummel Levine, Pascale
2003 Sep;29(3):172-178, Diagnostic cytopathology
Leiomyosarcoma of the breast is rarely encountered in fine-needle aspiration (FNA) cytologic material. We report a case of primary leiomyosarcoma of the breast in a 52-yr-old female. Aspiration cytology showed large, dissociated round to spindle cells with abundant vacuolated cytoplasm, pleomorphic nuclei, prominent nucleoli, and occasional intranuclear cytoplasmic invaginations. Mitotic figures, osteoclast-like giant cells, and stromal fragments were identified. A diagnosis of malignant neoplasm representing either a sarcoma, a poorly differentiated carcinoma, or a metaplastic carcinoma was made. The patient underwent a wide excision of the lesion after negative work-up. Histologic examination and immunohistochemical studies established the diagnosis of leiomyosarcoma. This case is presented here because we feel that, although FNA cytology with eventual ancillary studies is a valuable diagnostic tool to evaluate any breast mass, malignant spindle cell neoplasms of the breast still represent a diagnostic challenge for the cytopathologist. Recognition of all cytologic features of leiomyosarcoma may help to formulate a correct diagnosis. Diagn. Cytopathol. 2003;29:172-178
— id: 37242, year: 2003, vol: 29, page: 172, stat: Journal Article,

Indigent breast cancer patients among all racial and ethnic groups present with more advanced disease compared with nationally reported data
Naik, Arpana M; Joseph, Kathy; Harris, Marcia; Davis, Christine; Shapiro, Richard; Hiotis, Karen L
2003 Oct;186(4):400-403, American journal of surgery
BACKGROUND: This study examines the epidemiologic and pathologic characteristics of indigent breast cancer patients followed up in a public city hospital in comparison to national standards. METHODS: A prospective oncology database was queried to identify all patients presenting with primary breast cancer. Medical records of 188 patients identified between March 1997 and May 2002 were retrospectively reviewed. Pathologic and epidemiologic data were compared with 1998 data reported by the Surveillance, Epidemiology, and End Results (SEER) program. RESULTS: Among the patient population 10% were Caucasian, 13% African-American, 49% Hispanic, 25% Chinese, and 6% were of other background. The majority of patients were uninsured. Indigent patients within each ethnic group presented with more advanced disease when compared with patients reported by SEER. CONCLUSIONS: Indigent patients among all ethnic and racial backgrounds present with more advanced disease when compared with national statistics reported by SEER. The majority of these patients is uninsured and would benefit from more aggressive education, screening, detection methods, and follow-up
— id: 39033, year: 2003, vol: 186, page: 400, stat: Journal Article,

Orthotopic hindlimb transplantation in the rat: a technically challenging but useful animal model for solid organ engraftment
Hiotis SP; Wnuk KL; Blumenthals WA; Halaris SA; Good RA
1999 May;31(3):1567-1568, Transplantation proceedings
— id: 19631, year: 1999, vol: 31, page: 1567, stat: Journal Article,

Successful limb transplantation across a multi-minor barrier facilitated by preceding engraftment of T-cell-purged donor and recipient bone marrow
Hiotis SP; Wnuk KL; Blumenthals WA; Halaris SA; Good RA
1999 Feb-Mar;31(1-2):692-693, Transplantation proceedings
— id: 19632, year: 1999, vol: 31, page: 692, stat: Journal Article,

Donor-specific tolerance to orthotopic hindlimb allografts in the rat utilizing mixed cell chimerism
Hiotis, SP; Wnuk, KL; Blumenthals, WA; Halaris, SA; Good, RA
1998 MAR 20 ;12(5):A901-A901, FASEB journal
— id: 43620, year: 1998, vol: 12, page: A901, stat: Journal Article,