Laura Rosenberger

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 2003

Eastern Mennonite University

M.D. 2008

Thomas Jefferson University, Sidney Kimmel Medical College

General Surgery Resident, Surgery

University of Virginia School of Medicine

Breast Surgical Oncology Fellow, Surgery

Memorial Sloan-Kettering Cancer Center

Publications:

RFID Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology.

BACKGROUND: Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction. METHODS: Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography. RESULTS: Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median = 0, range = 0-3) new instruments were added per case; odds of instrument use did not change between cases (OR = 1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies. CONCLUSIONS: Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.
Authors
Olivere, LA; Hill, IT; Thomas, SM; Codd, PJ; Rosenberger, LH
MLA Citation
Olivere, Lindsey A., et al. “RFID Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology.J Surg Res, vol. 264, Apr. 2021, pp. 490–98. Pubmed, doi:10.1016/j.jss.2021.02.049.
URI
https://scholars.duke.edu/individual/pub1480386
PMID
33857793
Source
pubmed
Published In
J Surg Res
Volume
264
Published Date
Start Page
490
End Page
498
DOI
10.1016/j.jss.2021.02.049

Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines.

PURPOSE: Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary. METHODS: We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR). RESULTS: Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96). CONCLUSION: In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.
Authors
Rosenberger, LH; Thomas, SM; Nimbkar, SN; Hieken, TJ; Ludwig, KK; Jacobs, LK; Miller, ME; Gallagher, KK; Wong, J; Neuman, HB; Tseng, J; Hassinger, TE; King, TA; Jakub, JW
MLA Citation
Rosenberger, Laura H., et al. “Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines.J Clin Oncol, vol. 39, no. 3, Jan. 2021, pp. 178–89. Pubmed, doi:10.1200/JCO.20.02647.
URI
https://scholars.duke.edu/individual/pub1468623
PMID
33301374
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
39
Published Date
Start Page
178
End Page
189
DOI
10.1200/JCO.20.02647

Isolated liver metastasis from a malignant phyllodes presenting with hemoperitoneum.

Authors
Miller, KN; McGuire, EL; Yon, JR; Sutherland, JD; Meyer, MA; Rosenberger, LH
MLA Citation
Miller, Krislyn N., et al. “Isolated liver metastasis from a malignant phyllodes presenting with hemoperitoneum.Breast J, vol. 26, no. 11, Nov. 2020, pp. 2246–47. Pubmed, doi:10.1111/tbj.14076.
URI
https://scholars.duke.edu/individual/pub1463398
PMID
33051939
Source
pubmed
Published In
Breast J
Volume
26
Published Date
Start Page
2246
End Page
2247
DOI
10.1111/tbj.14076

The Incidence of Adjacent Synchronous Invasive Carcinoma and/or Ductal Carcinoma In Situ in Patients with Intraductal Papilloma without Atypia on Core Biopsy: Results from a Prospective Multi-Institutional Registry (TBCRC 034).

BACKGROUND: Available retrospective data suggest the upgrade rate for intraductal papilloma (IP) without atypia on core biopsy (CB) ranges from 0 to 12%, leading to variation in recommendations. We conducted a prospective multi-institutional trial (TBCRC 034) to determine the upgrade rate to invasive cancer (IC) or ductal carcinoma in situ (DCIS) at excision for asymptomatic IP without atypia on CB. METHODS: Prospectively identified patients with a CB diagnosis of IP who had consented to excision were included. Discordant cases, including BI-RADS > 4, and those with additional lesions requiring excision were excluded. The primary endpoint was upgrade to IC or DCIS by local pathology review with a predefined rule that an upgrade rate of ≤ 3% would not warrant routine excision. Sample size and confidence intervals were based on exact binomial calculations. Secondary endpoints included diagnostic concordance for IP between local and central pathology review and upgrade rates by central pathology review. RESULTS: The trial included116 patients (median age 56 years, range 24-82) and the most common imaging abnormality was a mass (n = 91, 78%). Per local review, 2 (1.7%) cases were upgraded to DCIS. In both of these cases central pathology review did not confirm DCIS on excision. Additionally, central pathology review confirmed IP without atypia in core biopsies of 85/116 cases (73%), and both locally upgraded cases were among them. CONCLUSION: In this prospective study of 116 IPs without atypia on CB, the upgrade rate was 1.7% by local review, suggesting that routine excision is not indicated for IP without atypia on CB with concordant imaging findings.
Authors
Nakhlis, F; Baker, GM; Pilewskie, M; Gelman, R; Calvillo, KZ; Ludwig, K; McAuliffe, PF; Willey, S; Rosenberger, LH; Parker, C; Gallagher, K; Jacobs, L; Feldman, S; Lange, P; DeSantis, SD; Schnitt, SJ; King, TA
URI
https://scholars.duke.edu/individual/pub1462551
PMID
33047246
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
2573
End Page
2578
DOI
10.1245/s10434-020-09215-w

Variable Practice Patterns in a Contemporary Multi-institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrate a Need for More Individualized Margin Guidelines

Authors
Rosenberger, L; Thomas, S; Nimbkar, S; Hieken, T; Ludwig, K; Jacobs, L; Miller, M; Gallagher, K; Wong, J; Neuman, H; Tseng, J; Hassinger, T; Jakub, J
MLA Citation
URI
https://scholars.duke.edu/individual/pub1475877
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
27
Published Date
Start Page
S492
End Page
S493