First indicators of relapse in breast cancer: evaluation of the follow-up program at our hospital.

BACKGROUND: Guidelines for breast cancer patient follow-up have not been widely adopted in Japan. To assess our intensive follow-up program, we evaluated first relapse and its indicators in patients with breast cancer. PATIENTS: Of 964 patients, 126 relapsed and 43 died in the median follow-up term of 45 months. Follow-ups were scheduled every 6-12 months for imaging and tumor marker (TM) evaluation. RESULTS: Of 126 relapsed patients, 30 (23.8%) had symptoms of relapse. First indicators of relapse in 96 asymptomatic patients were physical examination in 24 patients (19%); imaging, 57 patients (45.3%); and TMs, 15 patients (11.9%). The most sensitive indicators were physical examination for local relapse, ultrasonography for regional lymph nodes, scintigraphy for bone, computed tomography for lung, and TMs for liver metastasis. During intensive follow-up, 43% of relapsed patients were identified by symptoms or physical examination. These patients had poor prognosis compare to patients identified by imaging or TMs in overall survival and post-relapse survival (p = 0.009 and 0.019, respectively). In all 964 patients, the relapse rates for stage I, IIA, IIB, and III tumors were 7.4, 7.9, 19.9, and 43.5%, respectively. The percentage of first relapse detected by imaging or TMs for stage I, IIA, IIB, and III were 4.7, 5.1, 11.8, and 19.8%, respectively. The cost of our follow-up program for 10 years was approximately 290,000 yen per patient. CONCLUSION: A routine intensive follow-up program involving imaging and evaluation of TMs in all patients has low efficacy and high expenditure.

[Evaluation of scatter rejection system using a metal filter].

Grids are used for the purpose of reducing scattered radiation. In portable radiography, however, accurate positioning of the grid is difficult. Errors in alignment may cut off the primary beam, which can result in misdiagnosis. We devised a metal filter with scatter rejection properties and evaluated its performance. The filter, which has no intrinsic alignment mechanism, is placed in front of the IP. We evaluated aluminum (Al), copper (Cu), and tantalum (Ta) filters by comparing them with low-ratio grids of 3:1 and 5:1. In the total evaluation, Ta (0.03mm) demonstrated high visualization of light and minute vascular shadow and visceral pleura, and the Bucky factor was lower than that of the 3:1 grid, while the clinical target was very clear. Because of its high atomic number, Ta can absorb a low energy component effectively even if it is very thin. Because of the K absorption edge, Ta also decreases the high-energy components that cause photographic contrast to decline. Therefore, Ta proved to be a highly suitable material for this research. An air gap within 4cm was not effective for the purpose of supporting the reduction in scattered radiation of the metal filter. The method of placing a metal filter in contact with the patient is more practical and makes the system very thin. This system is thought to be effective for portable radiography because it is light, easy to use, and flexible in structure and does not cause misalignment.