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BACKGROUND: In invasive breast cancer, there are no differences among the mid- and long-term oncological safety results of nipple-sparing mastectomy (NSM), skin-sparing mastectomy (SSM), and simple mastectomy (SM). There are several reports comparing NSM and SSM with SM in the context of ductal carcinoma in situ (DCIS); however, the eligibility criteria vary among institutions, and there are no reports that compare all three surgical methods simultaneously within the same institution. This study aimed to compare the local recurrence and survival rates of the three techniques (NSM, SSM, and SM) in Japanese patients undergoing mastectomy for DCIS. METHODS: Patients undergoing NSM, SSM, or SM at our institution between 2006 and 2015 were identified, and their outcomes were analyzed. RESULTS: The mean follow-up period was 80.4 months (standard deviation [SD]: 37.1 months). NSM was performed in 152 cases, SSM in 49, and SM in 44. Five of 245 patients developed local recurrences. Four of these patients had invasive cancer. The primary endpoints of 5-year cumulative local recurrence were 2.4% (95% confidence interval [CI]: 0.0-5.0) for NSM, 2.2% (95% CI: 0.0-6.3) for SSM, and 0% (95% CI: 0.0-0.0) for SM. There were no significant differences among the 5-year local recurrence rates. CONCLUSIONS: In this single-center, retrospective study, the oncological safety of SSM and NSM for DCIS was comparable to that of conventional SM.
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Emerging evidence regarding the effectiveness of locoregional therapies (LRTs) for breast cancer has prompted investigation of the potential role of interventional radiology (IR) in the care continuum of patients with breast cancer. The Society of Interventional Radiology Foundation invited 7 key opinion leaders to develop research priorities to delineate the role of LRTs in both primary and metastatic breast cancer. The objectives of the research consensus panel were to identify knowledge gaps and opportunities pertaining to the treatment of primary and metastatic breast cancer, establish priorities for future breast cancer LRT clinical trials, and highlight lead technologies that will improve breast cancer outcomes either alone or in combination with other therapies. Potential research focus areas were proposed by individual panel members and ranked by all participants according to each focus area's overall impact. The results of this research consensus panel present the current priorities for the IR research community related to the treatment of breast cancer to investigate the clinical impact of minimally invasive therapies in the current breast cancer treatment paradigm.
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BACKGROUND: A couples' psycho-educational program called Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy was created and its effect when provided before cancer treatment was examined. METHODS: This multicenter randomized controlled trial with nonmasking, parallel two-group comparison enrolled women aged 20 to 39 years with early-stage breast cancer and their partners. They were randomly assigned to receive O!PEACE (37 couples) or usual care (37 couples). Primary end points were cancer-related posttraumatic stress symptoms, symptoms of depression, and anxiety. Secondary end points were stress-coping strategies, resilience, and marital relationship. RESULTS: Women receiving psycho-educational therapy had significantly reduced Impact of Event Scale-revised version for Japanese scores (p = .011, ηp 2 = = .089). For patients with Impact of Event Scale-revised version for Japanese scores at baseline ≥18.27, O!PEACE therapy improved these scores when compared with usual care (U = 172.80, p = .027, r = 0.258). A >5-point reduction was present in 59.3% and 30% of women in the O!PEACE therapy and usual-care groups, respectively. For partners, O!PEACE therapy significantly improved stress-coping strategies (95% CI, -0.60 to -0.05; p = .018, ηp 2 = = .074) and escape-avoidance marital communication (95% CI, -0.33 to -0.08; p = .001, ηp 2 = .136). O!PEACE therapy significantly improved the partners' support (95% CI, 0.10-0.50; p = .001, ηp 2 = .127), the rate of receiving fertility preservation consultations, and knowledge levels. CONCLUSIONS: O!PEACE therapy before cancer treatment can improve posttraumatic stress symptoms, stress-coping behavior, and marital relationships. Larger sample sizes and longer term follow-up are required. PLAIN LANGUAGE SUMMARY: A psycho-educational program, the Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy program was developed and evaluated for women diagnosed with breast cancer and their partners. A multicenter randomized controlled trial showed that the O!PEACE psycho-educational therapy, with only two precancer treatment sessions, can reduce cancer-related posttraumatic stress symptoms and improve oncofertility knowledge and marital relationships in young adult patients with breast cancer. The therapy could also improve stress-coping strategies in marital communications with their partners. Couples may use O!PEACE psycho-educational therapy to consider fertility preservation and improve their psychosocial aspects.
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Neoplasias de la Mama , Preservación de la Fertilidad , Humanos , Femenino , Adulto Joven , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/terapia , Neoplasias de la Mama/psicología , Adaptación Psicológica , Ansiedad , MatrimonioRESUMEN
We evaluated the efficacy and safety of the RV21-01 scalp cooling device in controlling hair loss during chemotherapy in this study. Thirty-nine breast cancer patients who underwent anthracycline- and/or taxane-based chemotherapy were assigned to the scalp cooling group(27 patients)and the hair loss observation group(12 patients). The alopecia rate using the NCI alopecia toxicity criteria and the quantitative alopecia toxicity grade was 51.9%(14/27 patients)and 100%(12/12 patients)in the scalp cooling and hair loss observation groups, respectively. Regarding safety, all subjects in both the scalp cooling and hair loss observation groups experienced adverse events; only 1 subject in each group experienced a severe adverse event due to chemotherapy and majority of the subjects in both groups experienced minor adverse events. RV21-01 scalp cooling therapy was demonstrated to be effective in reducing hair loss in patients undergoing standard chemotherapy for breast cancer. In addition, the adverse events associated with the scalp cooling therapy were minor and mild, and hence, deemed acceptable.
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Antineoplásicos , Neoplasias de la Mama , Hipotermia Inducida , Humanos , Femenino , Neoplasias de la Mama/complicaciones , Cuero Cabelludo , Alopecia/inducido químicamente , Alopecia/prevención & control , Alopecia/tratamiento farmacológico , Hipotermia Inducida/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antineoplásicos/efectos adversosRESUMEN
INTRODUCTION: This is a prospective single arm clinical trial on cryosurgery for early breast cancers, to evaluate the expanded criteria to tumors larger than 1.5 cm and non-luminal breast cancers. METHODS: Inclusion criteria include Solitary T1 breast cancers of any immunohistotypes. Cryosurgery was performed using the IceCure ProSense Cryoablation System. Lumpectomy of the cryoablated tumor was then performed 8 weeks after cryosurgery. RESULTS: Fifteen patients underwent cryosurgery followed by lumpectomy (BCS). Median age was 53 years old 5 (33.3%) patients had ductal carcinoma in situ (DCIS), while 10 (66.7%) patients had invasive ductal carcinoma (IDC), of which 5 (50%) patients had luminal type cancers of which 3 (60%) were luminal A and 2 (40%) luminal B, 3 (30%) patients had HER2 enriched invasive carcinoma and 2 (20%) patients had triple negative IDC. Median tumor size was 13mm (Range 8.6-18mm). Seven (46.7%) patients were found to have residual cancer in the post-cryosurgery lumpectomy specimen. All residual cancers were found at the periphery of the cryoablated breast tissue. All breast cancers were otherwise completely ablated centrally as confirmed by routine histopathology, immunochemistry and TUNEL assay for evaluation of cell viability. None of the tumor factors such as tumor biology, as well as surgical factors such as ablation time and iceball size, were associated with risk of residual cancer. None of the 15 patients developed post-operative complications. CONCLUSION: Residual cancer occurs at the periphery of the cryoablation site, careful pre-operative planning and intra-operative monitoring is crucial to ensure complete cryoablation.
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Neoplasias de la Mama , Carcinoma Intraductal no Infiltrante , Criocirugía , Humanos , Persona de Mediana Edad , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Criocirugía/efectos adversos , Neoplasia Residual/cirugía , Estudios Prospectivos , Carcinoma Intraductal no Infiltrante/cirugía , Carcinoma Intraductal no Infiltrante/patologíaRESUMEN
Background: Breast cancer is the most common cancer in women worldwide with an estimated 2.3 million breast cancer cases diagnosed annually. The outcome of breast cancer management varies widely across the globe which could be due to a multitude of factors. Hence, a blanket approach in standardisation of care across the world is neither practical nor feasible. Aim: To assess the extent and type of variability in breast cancer management across the globe and to do a gap analysis of patient care pathway. Method: An online questionnaire survey and virtual consensus meeting was carried out amongst 31 experts from 25 countries in the field of breast cancer surgical management. The questionnaire was designed to understand the variability in diagnosis and treatment of breast cancer, and potential factors contributing to this heterogeneity. Result: The questionnaire survey shows a wide variation in breast surgical training, diagnosis and treatment pathways for breast cancer patients. There are several factors such as socioeconomic status, patient culture and preferences, lack of national screening programmes and training, and paucity of resources, which are barriers to the consistent delivery of high-quality care in different parts of the world. Conclusion: On-line survey platforms distributed to global experts in breast cancer care can assess gaps in the diagnosis and treatment of breast cancer patients. This survey confirms the need for an in-depth gap analysis of patient care pathways and treatments to enable the development of personalised plans and policies to standardise high quality care.
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BACKGROUND: The multinational BREAKOUT study (NCT03078036) sought to determine the prevalence of germline BRCA1/2 (gBRCA1/2) and somatic BRCA1/2 (sBRCA1/2) mutations and mutations in other homologous recombination repair (HRR) genes in women with HER2-negative metastatic breast cancer (MBC) starting first-line chemotherapy. METHODS: Genetic testing for gBRCA, sBRCA, and HRR gene mutations was performed in patients who started first-line chemotherapy for MBC in the last 90 days (341 patients across 14 countries) who were not selected based on risk factors for gBRCA mutations. We report data from the Asian cohort, which included patients in Japan (7 sites), South Korea (10 sites), and Taiwan (8 sites). RESULTS: Of 116 patients screened, 104 patients were enrolled in the Asian cohort. The median age was 53.0 (range 25-87) years. gBRCA1/2, gBRCA1, and gBRCA2 mutations were detected in 10.6% (11/104), 5.8% (6/104), and 4.8% (5/104) of patients, respectively; none had mutations in both gBRCA1 and gBRCA2. gBRCA1/2 mutations were detected in 10.0% (6/60) and 11.6% (5/43) of patients with hormone receptor-positive and triple-negative MBC, respectively. HRR gene mutations were tested in 48 patients without gBRCA mutations, and 5 (10.4%) had at least one HRR mutation in sBRCA, ATM, PALB2, and CHEK2. CONCLUSION: We report for the first time the prevalence of gBRCA and HRR mutations in an Asian cohort of patients with HER2-negative MBC. Our results suggest that BRCA mutation testing is valuable to determine appropriate treatment options for patients with hormone receptor-positive or triple-negative MBC. STUDY REGISTRATION: NCT03078036.
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Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias de la Mama/genética , Mutación , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Pueblo Asiatico/genética , Proteínas de la Ataxia Telangiectasia Mutada/genética , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Quinasa de Punto de Control 2/genética , Proteína del Grupo de Complementación N de la Anemia de Fanconi/genética , Femenino , Humanos , Persona de Mediana Edad , Estudios Observacionales como Asunto , PrevalenciaRESUMEN
In 2018, olaparib, a PARP inhibitor, was approved for the treatment of BRCA1/2 gene-mutation positive and HER2-negative inoperable and recurrent breast cancer; BRCA1/2 gene testing was also listed as a companion diagnostics. Here, we identified microRNAs(miRNAs) expressed after treatment with olaparib, which differed in the presence or absence of BRCA1 mutations in triple negative breast cancer(TNBC), and examined the changes in miRNAs after exposure to the combination of the PARP-1 inhibitor and a chemotherapeutic agent. After exposure to the PARP-1 inhibitor, the expression of miR-141, miR-155, miR-205, and miR-223 decreased in MDA-MB-231, HCC1143, and BT549 cells and increased more than 10 times in MDA-MB-436 cells. Moreover, the expression of miR-141 in MDA-MB-436 cells treated with the PARP-1 inhibitor together with gemcitabine increased more than 10 times; additionally, the expression of miR-205 increased more in the context of combination therapy versus single exposure to olaparib. The miR-200 family(including miR-141)and miR- 205 are known to function as ZEB1/2 targets and to act as epithelial-to-mesenchymal transition(EMT)-suppressors. Overall, these results suggest that it may be possible to recover the sensitivity of TNBC cells to chemotherapy via the suppressing EMT through the use of a PARP-1 inhibitor in the context of BRCA1 mutation.
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MicroARNs , Neoplasias de la Mama Triple Negativas , Proteína BRCA1/genética , Línea Celular Tumoral , Humanos , MicroARNs/genética , Mutación , Recurrencia Local de Neoplasia , Ftalazinas , Piperazinas , Inhibidores de Poli(ADP-Ribosa) Polimerasas/farmacología , Inhibidores de Poli(ADP-Ribosa) Polimerasas/uso terapéutico , Neoplasias de la Mama Triple Negativas/tratamiento farmacológico , Neoplasias de la Mama Triple Negativas/genéticaRESUMEN
Locally advanced breast cancer sometimes results in a large chest wall defect at mastectomy. When closing the wound horizontally, the skin tension is usually severe in the middle of the wound, while the skin of the lateral area tends to make a dog-ear deformity. Triangle technique is a procedure to prevent the dog ear in which the skin and subcutaneous fat of the axilla are cut into an equilateral triangle. Herein, we present a case of breast cancer who underwent a mastectomy and closed the wound with a skin graft by utilizing the skin removed from lateral thoracic area using triangle technique. An 85-year-old female visited our institution complaining about the mass on her right breast. Preoperative images showed a 10 cm-sized mass with suspicious axillary and mediastinal lymph nodes swelling. A biopsy revealed a hormone receptor-negative, HER2-positive invasive ductal carcinoma. A mastectomy and axillary lymph node sampling were performed for a local control as the tumor did not respond to four cycles of triweekly trastuzumab combined with S-1. After a transverse elliptical incision, a skin of the lateral thoracic area was harvested using triangle technique. As the middle of the wound had excessive closing tension, the skin was grafted on the defect. After 10 day fixation by a tie-over dressing, the wound healed without complications. This procedure is a simple method for closing a large defect after mastectomy preventing both the dog-ear deformity and a new wound scarring of a donor site.
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Neoplasias de la Mama/cirugía , Carcinoma Ductal/cirugía , Mamoplastia/métodos , Mastectomía/métodos , Trasplante de Piel/métodos , Pared Torácica/cirugía , Anciano de 80 o más Años , Antimetabolitos Antineoplásicos/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Axila , Biopsia , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Carcinoma Ductal/tratamiento farmacológico , Carcinoma Ductal/patología , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/patología , Ácido Oxónico/uso terapéutico , Colgajos Quirúrgicos , Tegafur/uso terapéutico , Trastuzumab/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: To document 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings after percutaneous cryoablation for early breast cancer. METHODS: Data of 193 consecutive patients who had undergone cryoablation for invasive ductal carcinoma or ductal carcinoma in situ ≤ 15 mm without a history of ipsilateral breast cancer, synchronous ipsilateral lesion, and with estrogen receptor positive/human epidermal growth factor 2 negative were enrolled. The imaging characteristics of the treated areas were evaluated and classified on CT images as one of two types: fatty mass or non-fatty mass type. The maximum standardized uptake value (SUVmax) of the initial post-cryoablation PET/CT, the CT type of the treated area and selected clinical factors (age, menopausal status, lesion area, breast density, timing of PET/CT) were retrospectively evaluated. RESULTS: The median interval between cryoablation and the initial post-cryoablation PET/CT was 12 months. The median SUVmax of the treated area was 1.36. The CT findings of the treated area were classified as fatty mass type (n = 137, 71.0%) or non-fatty mass type (n = 56, 29.0%). The treated areas of patients with lower breast density, of older age, post-menopausal status, and lower radiation dose were significantly more likely to be of fatty mass type (P < 0.001). Non-fatty mass type averaged a significantly higher SUVmax than did fatty mass type. CONCLUSIONS: Post-cryoablation PET/CT findings are of fatty or non-fatty mass type. A non-fatty appearance, which can show higher SUVmax, does not necessarily denote recurrence.
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Neoplasias de la Mama/diagnóstico por imagen , Criocirugía/métodos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Adulto , Anciano , Neoplasias de la Mama/cirugía , Criocirugía/efectos adversos , Femenino , Fluorodesoxiglucosa F18 , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones/normas , RadiofármacosRESUMEN
PURPOSE: To evaluate the diagnostic potential of simultaneous multi-slice echo-planar diffusion-weighted imaging (DWI) (SMS-DWI). MATERIALS AND METHODS: A total of 55 consecutive patients underwent breast magnetic resonance imaging (MRI) between April and September 2018. SMS-DWI and single-shot echo-planar DWI (SS-EPI-DWI) sequences were obtained with the following parameters: b value, 0, 850, and 1200 mm2/s for both; spacing between sections, 2 mm for SMS-DWI and 3 mm for SS-EPI-DWI. Lesion visibility was assessed by two radiologists, and minimal and maximal apparent diffusion coefficients (ADCs) for masses were measured. The Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were performed. RESULTS: Of the 55 cases, 23 (41.8%) were malignant and 32 (58.2%) were benign. Visual conspicuity was superior on SMS-DWI in 47.1% (n = 16/34) or 55.9% (n = 19/34) among the lesions visible on DWI and ADC. ROC curve analyses revealed an area under the curve of 0.87 [95% confidence interval (CI) 0.68-1.00], 0.94 (95% CI 0.86-1.00), 0.93 (95% CI 0.84-1.00) and 0.90 (95% CI 0.77-1.00) for minimal and maximal ADC on SMS-DWI and ADC on SS-EPI-DWI, respectively. CONCLUSION: Simultaneous multi-slice technique provided breast DWI of better visual conspicuity and comparable diagnostic performance with shorter acquisition time.
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Neoplasias de la Mama/diagnóstico por imagen , Mama/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética/métodos , Imagen Eco-Planar/métodos , Adulto , Área Bajo la Curva , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Curva ROCRESUMEN
Purpose: This study aimed to assess the efficacy of scalp-cooling devices in preventing chemotherapy-induced alopecia in Japanese breast cancer patients and investigate whether a scalp-cooling device improves hair volume recovery over a 12 weeks period after completing chemotherapy. Methods: This multicenter controlled trial included women with breast cancer undergoing chemotherapy in Japan between February 2016 and March 2018. The primary endpoint was the proportion of patients with no alopecia at the end of chemotherapy. The secondary endpoint included hair volume at 12 weeks after completing chemotherapy. Results: A total of 48 patients were enrolled; of them, 34 and 14 were sequentially allocated to the scalp-cooling group using the Paxman Hair Loss Prevention System and the control group, respectively. There was no significant difference in average age between the scalp-cooling and the control groups (50.0 ± 9.6 vs. 49.0 ± 9.0 years). More than 50% of patients in each group had stage II breast cancer (scalp-cooling group: 53.1%; control group: 64.3%), more than 90% received adjuvant chemotherapy (scalp-cooling group: 96.9%; control group: 92.9%), and more than 60% were treated with a docetaxel/cyclophosphamide regimen (scalp-cooling group: 75.0%; control group: 64.3%). There were more patients judged to have no alopecia at the end of chemotherapy in the scalp-cooling group than in the control group (26.7% [8/30] vs. 0% [0/13]; P = 0.011). The proportion of patients with alopecia who experienced an increase in hair volume of ≥50% within 12 weeks duration after chemotherapy was 85.7% (24/28) in the scalp-cooling group and 50.0% (6/12) in the control group. No patient developed serious adverse events related to the scalp-cooling device. Conclusions: The use of a scalp-cooling device prevented alopecia with acceptable safety for Japanese patients. In addition, scalp cooling resulted in faster recovery of hair volume after chemotherapy, even in patients for whom scalp cooling failed to prevent chemotherapy-induced alopecia.
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RATIONALE AND OBJECTIVES: To retrospectively evaluate findings on serial magnetic resonance imaging (MRI) after cryoablation for breast cancer lesions without subsequent surgical resection. MATERIALS AND METHODS: This study was approved by the Institutional Review Board and the requirement to obtain informed consent waived. Ductal carcinoma in situ or invasive carcinoma ≤15 mm, nuclear grade 1 or 2, estrogen receptor positive/human epidermal growth factor 2 negative without lymph node metastasis were treated with cryoablation without subsequent excision. Two observers independently reviewed the first two postcryoablation MRIs for shape (none, focus-to-mass, or nonmass enhancement) and suspicion of residual disease (positive or negative). Fisher's exact or the Mann-Whitney U test was used to assess significance. Interobserver agreement on findings was evaluated by calculating κ values. RESULTS: Fifty-four patients were enrolled. The first and second postcryoablation MRIs were performed 22-171 days and 82-487 days after cryoablation, respectively. Interobserver agreement ranged from fair to moderate (κâ¯=â¯0.356-0.434). Observer 1 or 2 identified suspicious areas on the first postcryoablation MRI in seven cases (13.0%). These were significantly associated with focus-to-mass shape (vs non-focus-to-mass: nonmass enhancement or none) and residual disease or recurrence suspected by both observers (p < 0.001). There were no cases of both observers identifying suspicious findings on the second postcryoablation MRI. CONCLUSION: Suspicious findings can be detected within the treated area at the first postcryoablation MRI. These can resolve during subsequent adjuvant therapies and follow-up.
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Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Criocirugía/métodos , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Mama/diagnóstico por imagen , Mama/patología , Mama/cirugía , Neoplasias de la Mama/patología , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: The existence of progesterone receptor (PgR) expression in oestrogen receptor (ER)-negative breast carcinoma is controversial. Here, we re-evaluated ER-negative/PgR-positive (ER-/PgR+) carcinoma cases by immunohistochemical staining (IHC). MATERIALS AND METHODS: We selected patients who underwent surgery for primary breast carcinoma from our databases at Dokkyo Medical University Hospital and Kameda General Hospital. Among the 9844 patients, the largest series in Japan, 27 (0.3%) were initially diagnosed as ER-/PgR+ breast carcinomas and we re-evaluated by IHC. RESULTS: The re-evaluated IHC showed that of the 27 patients with the initial results of ER-/PgR+, 12 were ER+/PgR+, 8 were ER-/PgR-, and 7 were ER-/PgR+. ER was negative in 12 of 27 patients (44.4%), and PgR was positive in 8 of 27 patients (29.6%). In our seven re-evaluated and confirmed as ER-/PgR+ cases, the staining proportions of tumor cells were 0% in ER and 1-69% (average 15.8%) in PgR. The average staining proportion of PgR in the re-evaluated ER-/PgR+ phenotype was lower than the initial diagnosis. Histological grading was as follows: grade I, one case; grade II, two cases; grade III, four cases. There were two lymph-node-positive cases. CONCLUSIONS: The ER-/PgR+ phenotype was confirmed after re-evaluation of ER and PgR assessment by a different pathologist. We recommend that pathologists discuss with clinicians, or re-test and re-evaluate ER/PgR expression, particularly in low-grade carcinoma and with a high staining proportion of PgR in the ER-/PgR+ phenotype.
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Neoplasias de la Mama/patología , Inmunohistoquímica/métodos , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Adulto , Anciano , Pueblo Asiatico , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/cirugía , Femenino , Humanos , Metástasis Linfática/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patologíaRESUMEN
BACKGROUND: Mastitis is a common complication in lactating women. However, the diversity of intestinal bacteria in infant exclusively fed infectious milk remains uncharacterized. Our colleagues recently established a method based on 16S and 23S rRNA-targeted reverse transcription-quantitative PCR (RT-qPCR) for detecting bacteria. MATERIALS AND METHODS: In the present study, the bacteria present in 14 samples of milk and infant feces were characterized using the RT-qPCR method, and concentrations of fecal organic acids were measured during the period of breast massage using HPLC. RESULTS: Streptococcus agalactiae and Str. parasanguinis were detected in milk from mastitis patients, whereas Str. salivarius and Str. thermophilus were the predominant bacteria in milk from engorged breasts. In feces of breastfed infants, Str. salivarius, Str. thermophiles, and Str. parasanguinis were isolated. Levels of lactate were high in fecal samples, whereas the pH of infant feces stabilized during breast massage. The bacterial diversity of milk from lactation infectious breasts was similar to that in feces of infant fed milk from lactation infectious breasts. Streptococcus species isolated from the feces of breastfed infants are related to oral cavity health. CONCLUSION: These results suggest that Streptococcus species, which are part of the healthy oral microflora, may play an important role in preserving the intestinal bacterial flora in infants fed infectious milk.
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BACKGROUND: Identification of the proteins that are associated with estrogen receptor (ER) status is a first step in selecting drugs against hormone-dependent breast cancer. Recently, the proteins associated with ER status were reported using liquid chromatography and tandem mass spectrometry, and microRNA (miRNA) profiling of breast cancer subtype was demonstrated using real-time-PCR. METHODS: We present herein two cases with differential protein expression and miRNA profiling in ER-positive and -negative breast cancer. RESULTS: Proteins associated with fatty acid metabolism were uniquely detected in ER-positive breast cancer. The level of miR-181a expression in ER-positive cancer was higher than that in ER-negative cancer, while the expression of miR-27a, miR-107, and miR-195 was lower in ER-positive compared with ER-negative cancer. CONCLUSION: These cases suggest that fatty acid synthase (FAS) and FAS-related miRNAs are important in ER-positive breast cancer.
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RATIONALE AND OBJECTIVES: We aimed to investigate the relationship between shear wave speed (SWS) of the lesion on preoperative breast ultrasonography (US) and disease-free survival of patients with primary operable invasive breast cancer. MATERIALS AND METHODS: This retrospective study was approved by our Institutional Review Board. The requirement for informed consent was waived. A total of 195 consecutive newly diagnosed invasive breast cancer patients (age 33-83 years; mean 54.0 years) with preoperative breast US with SWS measurement of the lesion were identified. They underwent surgery between May 2012 and May 2013. SWS was measured at the center and three marginal zones in the main tumors, and the maximum value was used for analyses. For 35 patients who underwent primary systemic therapy (PST), the maximum SWS before PST was used. Cox proportional hazards modeling was used to identify the relationship between clinical-pathologic factors and disease-free survival. RESULTS: Fourteen recurrences occurred at 6-47 months (mean 22.3 months) after surgery. On multivariate analysis, a positive history of PST (hazard ratio [HR] = 4.93; 95% confidence interval [CI]: 1.66, 14.70; P = .004), adjuvant chemotherapy (HR = 3.67; 95% CI: 1.11, 12.1; P = .033), and higher maximum SWS (HR = 1.55; 95% CI: 1.07, 2.23; P = .020) were associated with poorer disease-free survival. CONCLUSION: Higher maximum SWS on preoperative US, in addition to a positive history of PST and adjuvant chemotherapy, was significantly associated with poorer disease-free survival of patients with invasive breast cancer.
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Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/terapia , Carcinoma/diagnóstico por imagen , Carcinoma/terapia , Ultrasonografía Mamaria , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Carcinoma/patología , Quimioterapia Adyuvante , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante , Invasividad Neoplásica , Periodo Preoperatorio , Modelos de Riesgos Proporcionales , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate the usefulness of the HydroMARK, a hydrogel-based breast biopsy site marker for ultrasound localization of breast lesions, we investigated the tendency for dislocation and sonographic detectability of the marker placed in patients. MATERIALS AND METHODS: The marker was placed in lesions that were expected to become obscured after biopsy for a suspicious breast lesion or after neoadjuvant chemotherapy for breast cancer. The patients consented to return for a repeat ultrasound ± mammography examination, and the degree of displacement of the marker was measured as the marker-to-residual lesion distance. RESULTS: The marker was placed after stereotactic biopsy, ultrasound-guided biopsy, and before/during neoadjuvant chemotherapy, in 11, 22, and 7 lesions, respectively. Surgical resection was performed for 22 of the 40 lesions, while remaining 18 benign lesions were followed. The marker was sonographically detectable in 89.7% (35/39), 100% (35/35), and 100% (18/18) of the cases, respectively, at a median of 8 days, 13 weeks, and 11 months after the deployment. The degree of displacement was lower in the ultrasound-guided placement group than in the stereotactic placement group (median displacement: 0 vs. 4.3 mm; p = 0.001), it was also lower in the core-needle biopsy and neoadjuvent therapy cases than in the vacuum-assisted biopsy cases (p = 0.003). At a median interval of 2.5 months after deployment, the marker remained unchanged in location in all cases (n = 18, p = NS). CONCLUSIONS: The HydroMARK appears to be a safe and effective marker with the advantageous characteristics of a low tendency for dislocation with time and long-term sonographic detectability.
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Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Biopsia Guiada por Imagen/métodos , Ultrasonografía Mamaria/métodos , Adulto , Anciano , Neoplasias de la Mama/cirugía , Femenino , Humanos , Hidrogeles , Biopsia Guiada por Imagen/instrumentación , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía Mamaria/instrumentaciónRESUMEN
BACKGROUND: Eligibility of nipple-sparing mastectomy has been expanded. The purpose of this study was to evaluate interobserver agreement regarding magnetic resonance imaging (MRI) descriptors important in determining eligibility for mastectomy, and to investigate the significance of enhancement extending to the areola concerning nipple-areolar complex (NAC) involvement. METHODS: Fifty-one cases with histologically confirmed NAC involvement and 54 cases with negative NAC were enrolled. Two radiologists assessed the following factors: lesion morphology (mass or non-mass enhancement); intra-nipple bright signal; enhancement extending to the areola; abnormal nipple enhancement; and tumor-nipple distance. Factors that showed a significant association with outcome in the univariate analysis were assessed by means of multivariate analysis using a logistic regression model. Interobserver agreement between observers was assessed by calculating κ values (dichotomous variables), or intraclass correlation coefficients (ICCs; continuous variables). RESULTS: In multivariate analysis of the results from the two observers, tumor-nipple distance (observer 1: odds ratio [OR] 0.93; 95% confidence interval [CI] 0.88-0.99; observer 2: OR 0.89; 95% CI 0.83-0.95) and enhancement extending to the areola (observer 1: OR 17.9; 95% CI 1.97-162.2; observer 2: OR 24.0; 95% CI 2.62-219.7) were found to be significant predictors of NAC involvement. A substantial agreement (κ = 0.64-0.71) for every dichotomous variable and an almost perfect agreement (ICC = 0.86) for continuous variable were observed. CONCLUSIONS: Findings of breast MRI for NAC preservation had good interobserver agreement. Enhancement extending to the areola, together with tumor-nipple distance, was significant factors for NAC involvement.