Research Summary
- Clinical trials of neoadjuvant chemotherapy and targeted therapies for women with breast cancer
- Ductoscopy in the high-risk woman, biomarker studies on nipple fluid
- Image guided ablation of breast tumors
- Minimally invasive breast cancer surgery
Dr. Golshan's primary area of research is in clinical trials of neoadjuvant chemotherapy and targeted therapies for women with breast cancer. Most women with breast cancer are offered chemotherapy and/or hormonal therapy if their cancer is greater than one cm in size. The benefit of this therapy is for a small percentage of women. Dr. Golshan and his colleagues give women upfront therapy and follow the tumor response to these novel agents. Core biopsy specimens are taken prior to therapy, two weeks after the start of therapy and at the time of definitive surgery. Gene array studies looking for tumor response to the different therapy modalities are being pursued. Eventually, breast cancers will be typed and therapy tailored to the individual’s breast tumor characteristics. Dr. Golshan studies tumor response using novel imaging modalities such as Breast MRI.
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Locally advanced breast cancer before therapy. (Left) |
Locally advanced breast cancer after 12 weeks of preoperative chemotherapy with dramatic reduction in tumor volume. (Right) |
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DFCI/HCC Pre-operative Clinical Trials
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03-311 Pre-operative Trastuzumab/Vinorelbine versus Docetaxel/Carboplatin/Trastuzumab in Early Stage, HER-2 Positive Breast Cancer
Eligibility Criteria:
- Patients with Stage II or III breast cancer
- HER-2 positive tumors (IHC 3+ or FISH+)
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04-167 Pre-operative Capecitabine in Women with ER+ and/or PR+, Her2 Negative Operable Breast Cancer
Eligibility Criteria:
- Patients with Stage I-III operable breast cancer.
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05-098 Phase 2 Tarceva in Treatment-Naive Operable BrCA
Eligibility Criteria:
-Stage I or II (T1 or T2 & N0 or N1) invasive mammary
- Must have measurable residual disease and plan mastectomy or segmental resection
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Depiction of ductal lavage. |
Dr. Golshan's second area of interest is looking at ductoscopy in the high-risk women. Atypia on ductal lavage fluid is followed by ductoscopy to evaluate for intralumial pathology. This may be a valuable adjunct in evaluation of high-risk women. Fluid is being examined for protein markers in breast fluid using surface enhanced laser desorbtion ionization time-of-flight mass spectroscopy, (SEDI-TOF).
Traditional management of malignant and benign breast tumors has been through surgical excision. With the advent of novel ablation techniques such as focused ultrasound, cyrotherapy, laser and radiofrequency; ablation of the tumor can be done with minimal or no surgical incisions. Using MRI guidance and focused ultrasound for ablation, benign tumors such as fibroadenomas are being treated without surgery.
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Sentinel lymph node injection. |
Minimally invasive surgical techniques such as skin-sparing and nipple-sparing mastectomy are being used to allow women with breast cancer to undergo mastectomy and reconstruction with removal of the entire breast through the areola. Work is also being done with a technique that minimizes pain and bleeding during and after surgery with breast tumescence. Novel techniques such as sentinel lymph node biopsy are also being used to minimize the morbidity of axillary lymph node surgery.
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Intraoperative tumescence to decrease blood loss. |
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Funding
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Publications
For the latest articles by Dr. Mehra Golshan please visit 
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Golshan M, McHenry C, de Vente J, Kalajyian R, Hsu R, Tomashefski J. "Acute suppurative thyroiditis and necrosis of the thyroid gland: a rare endocrine manifestation of acquired immunodeficiency syndrome." Surgery. 1997 May;121(5):593-6.
Golshan M, Lotfi P, Prinz R. “Exploration for multiglandular disease in primary hyperparathyroidism.” Operative Techniques in General Surgery 1999, 1:85-95.
Kim A, Cacciopo J, Golshan M, Templeton A, Prinz R. "A pancreatic epithelial cyst in an adult treated by central pancreatectomy." J Gastrointest Surg. 2001 Nov-Dec;5(6):634-7.
Golshan M, Martin W, Dowlatshahi K. "Sentinel lymph node biopsy lowers the rate of lymphedema when compared to axillary lymph node dissection." Am Surg. 2003 Mar;69(3):209-11; discussion 212.
Christein J, Kim A, Golshan M, Maxhimer J, Deziel D, Prinz R. "Central pancreatectomy for the resection of benign or low malignant potential neoplasms." World J Surg. 2003 May;27(5):595-8.
Golshan M, Fung S, Wolfman J, Rademaker A, Morrow M. “The effect of ipsilateral whole breast ultrasonography on the surgical management of breast carcinoma.” Am J Surg. 2003 Oct;186(4):391-6.
Golshan M, Fung S, Wiley E, Wolfman J, Rademaker A, Morrow M. “Prediction of breast cancer size by ultrasound, mammography and core biopsy.” Breast. 2004 Aug;13(4):265-71.
Golshan M, Kuten A, William J, Richardson A, Modarressi A, Matulonis U. "Metaplastic carcinoma of the breast with neuroglial differentiation." Breast. 2005 Oct 24.
Golshan M, Lesnikoski B, Lester S. “Sentinel lymph node biopsy for occult breast cancer detected during breast reduction surgery." Am Surg. 2006 May;72(5):397-400.
Golshan M, Miron A, Nixon AJ, Garber JE, Cash EP, Iglehart JD, Harris JR, Wong JS. "The prevalence of germline BRCA1 and BRCA2 mutations in young women with breast cancer undergoing breast-conservation therapy."
Am J Surg. 2006 Jul;192(1):58-62.
Golshan M, Nakhlis F. "Can methylene blue only be used in sentinel lymph node biopsy for breast cancer?" Breast J. 2006 Sep-Oct;12(5):428-30.
Golshan M, Smith B. "Prevention and management of arm lymphedema in the patient with breast cancer."
J Support Oncol. 2006 Sep;4(8):381-6.
Rusby JE, Smith BL, Dominguez FJ, Golshan M. "Sentinel lymph node biopsy in men with breast cancer: a report of 31 consecutive procedures and review of the literature." Clin Breast Cancer. 2006 Dec;7(5):406-10.
Golshan M, Rusby J, Dominguez F, Smith BL. Breast conservation for male breast carcinoma. Breast. 2007 Jun 30.
Segara D, Krop IE, Garber JE, Winer E, Harris L, Bellon JR, Birdwell R, Lester S, Lipsitz S, Iglehart JD, Golshan M.
Does MRI predict pathologic tumor response in women with breast cancer undergoing preoperative chemotherapy?
J Surg Oncol. 2007 Jul 19.
Javid SH, Carlson JW, Garber JE, Birdwell RL, Lester S, Lipsitz S, Golshan M. Breast MRI Wire-Guided Excisional Biopsy: Specimen Size as Compared to Mammogram Wire-Guided Excisional Biopsy and Implications for Use. Ann Surg Oncol. 2007 Sep 11.
Carlson JW, Birdwell RL, Gombos EC, Golshan M, Smith DN, Lester SC. MRI-directed, wire-localized breast excisions: incidence of malignancy and recommendations for pathologic evaluation. Hum Pathol. 2007 Sep 12
Dominguez FJ, Golshan M, Black DM, Hughes KS, Gadd MA, Christian R, Lesnikoski BA, Specht M, Michaelson J, Smith BL. Sentinel Node Biopsy is Important in Mastectomy for Ductal Carcinoma In Situ. Ann Surg Oncol. 2007 Sep 22
Greenberg CC, Bafford AC, Golshan M. Is axillary dissection needed in node-positive breast cancer? Expert Rev Anticancer Ther. 2008 Feb;8(2):195-8.
Partridge A, Adloff K, Blood E, Dees EC, Kaelin C, Golshan M, Ligibel J, de Moor JS, Weeks J, Emmons K, Winer E. Risk perceptions and psychosocial outcomes of women with ductal carcinoma in situ: longitudinal results from a cohort study. J Natl Cancer Inst. 2008 Feb 20;100(4):243-51. Epub 2008 Feb 12.
Katz A, Smith BL, Golshan M, Niemierko A, Kobayashi W, Raad RA, Kelada A, Rizk L, Wong JS, Bellon JR, Gadd M, Specht M, Taghian AG.
Nomogram for the prediction of having four or more involved nodes for sentinel lymph node-positive breast cancer. J Clin Oncol. 2008 May 1.
Bafford AC, Burstein HJ, Barkley CR, Smith BL, Lipsitz S, Iglehart JD, Winer EP, Golshan M. Breast surgery in stage IV breast cancer: impact of staging and patient selection on overall survival. Breast Cancer Res Treat. 2008 Jun 26.
Partridge A, Winer JP, Golshan M, Bellon JR, Blood E, Dees EC, Sampson E, Emmons KM, Winer E. Perceptions and management approaches of physicians who care for women with ductal carcinoma in situ. Clin Breast Cancer. 2008 Jun;8(3):275-80.
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