Clinical benefits of tomosynthesis-guided vacuum assisted breast biopsy: a comparison with stereotactic vacuum assisted biopsy.

BACKGROUND: Tomosynthesis-guided vacuum assisted breast biopsy (3D-VAB) has been used increasingly. The aim of our study is to compare the clinical effectiveness of 3D-VAB and stereotactic vacuum assisted biopsy (2D-VAB) on the number of tissue cores containing targeted calcifications and on the procedure time. METHODS: Consecutive 87 women who underwent biopsy at our hospital from April 2020 to March 2022 for calcifications mammographically suspicious of malignancy were included in this study: 57 patients with 3D-VAB and 30 patients with 2D-VAB. RESULTS: Grouped or clustered calcified lesions were found in 39 and 21 patients among the 3D-VAB group and the 2D-VAB group, respectively. The mean number of tissue cores per biopsy containing targeted calcifications from the grouped or clustered calcified lesions was 3 and 2.3 specimens for the 3D-VAB group and for the 2D-VAB group, respectively. The mean procedure time for grouped or clustered calcifications was significantly shorter in the 3D-VAB group than in the 2D-VAB group (16.5 min vs. 27.4 min, P < 0.01). Comparing the procedure time between 3D-VAB and 2D-VAB based on calcification category, 3D-VAB had significantly shorter procedure time than 2D-VAB for both category 3 and category 4 calcification. For all patients, the mean procedure time was 18.1 min for the 3D-VAB group and 27.7 min for the 2D-VAB, thus being significantly shorter with 3D-VAB than 2D-VAB (P < 0.01). CONCLUSION: Our study demonstrated that the clinical effectiveness of 3D-VAB is superior to that of 2D-VAB and that the significant reduction in examination time with 3D-VAB is expected to benefit patients.

[Methods of preventing phlebitis induced by infusion of fosaprepitant].

At our hospital, we use aprepitant for nausea and vomiting when administering highly emetic anticancer agents, according to "Guidelines for the Appropriate Use of Antiemetic Agents" given by the Japan Society of Clinical Oncology. We initiated the intravenous administration of fosaprepitant for better compliance compared with aprepitant; however, we observed phlebitis after the infusion of fosaprepitant. Therefore, we investigated measures to reduce phlebitis associated with the infusion of fosaprepitant. For the first premedication, fosaprepitant (150 mg) was dissolved in 100 mL of saline and administered for 30 minutes; 1 of 2 patients showed grade 4 phlebitis. For the modified premedication, fosaprepitant, dexamethasone, and 5- HT(3) antagonist were dissolved in 100 mL of saline and administered for 30 minutes. The modified premedication was administered to a total of 27 patients; 5 patients developed mild phlebitis (grade 1), but infusion could be continued by treating their phlebitis with a hot pack. We used a combination of dexamethasone and 5-HT(3) antagonist with fosaprepitant as a modified premedication in order to avoid drug-induced vascular damage, which resulted in the pH decreasing to 6.20-7.55 (close to neutral) and a shorter infusion time.

Requirement of p38 MAPK for a cell-death pathway triggered by vorinostat in MDA-MB-231 human breast cancer cells.

Vorinostat is a histone deacetylase inhibitor that effectively suppresses cancer-cell proliferation by inducing cell-cycle arrest and/or apoptosis. We now show the involvement of p38 mitogen-activated protein kinase (MAPK) in the regulation of vorinostat-induced apoptosis in MDA-MB-231 human breast cancer cells. Vorinostat induced the hyperacetylation of histone H3, which correlated to apoptosis induction. Vorinostat-induced apoptosis occurred in parallel with the phosphorylation of p38 MAPK and the dephosphorylation of extracellular signal-regulated kinases 1 and 2 (ERK1/2). Knockdown of p38 MAPK prominently abrogated apoptosis induction and was accompanied by decreased caspase-3 cleavage. These findings support the notion that the activation of the p38 MAPK pathway followed by caspase-3 cleavage is responsible for vorinostat-induced apoptosis in MDA-MB-231 cells.

Endoscopic appearance and clinicopathological character of breast cancer.

BACKGROUND: The Japanese Association of Mammary Ductoscopy proposed a classification system based on the objective endoscopic appearance of intraductal lesions. This system includes four categories: solitary polypoid, multiple polypoid, superficial, and combined type. However, previous studies did not adequately compare endoscopic findings with histological findings and the prognosis. PATIENTS AND METHODS: One hundred and ten patients with nipple discharge who had intraductal tumors were identified by mammary ductoscopy, and 25 breast cancer patients were identified from our database of records between 2001 and 2008. The clinicopathological data and outcomes of these patients were then reviewed. RESULTS: Lesions in 25 breast cancer patients comprised 12 polypoid solitary type, 3 polypoid multiple type, 5 superficial type, and 5 combined type. Polypoid type showed a low sensitivity on cytological analysis (5 malignant and 10 benign). On the contrary, superficial or combined type showed a high sensitivity (4 malignant and 1 benign). Furthermore, invasive ductal carcinoma was frequently found in the solitary polypoid type. Actuarial disease-free survival for all patients at 10 years was 78%. The estrogen/progesterone receptor status and endoscopic appearance did not significantly affect disease-free survival (DFS), while there was a significant difference in DFS between ductal carcinoma in situ and invasive ductal carcinoma. CONCLUSION: Ductoscopy is a useful procedure for guiding subsequent breast surgery in the treatment of nipple discharge, and the appearance may be essential in treating breast cancer patients with nipple discharge.

Effects of short-term estrogen treatment on the progression of N-methyl-N-nitrosourea-induced premalignant mammary lesions in female Lewis rats.

We studied the effects of short-term estrogen treatment (STET) on the progression of mammary lesions from ductal hyperplasia (DH) through ductal carcinoma in situ (DCIS) to invasive ductal carcinoma (IDC) in the N-methyl-N-nitrosourea (MNU)-induced rat mammary carcinogenesis model. Three-week-old female Lewis rats (n = 40) received an intraperitoneal injection of MNU (50 mg/kg). Three weeks later, a 3-week-release, 0.25-mg, 17ß-estradiol pellet was subcutaneously implanted for 2 weeks in 20 rats (STET); the remaining 20 rats did not receive the estradiol pellets (age-matched control). All rats were killed at 12 weeks of age, and their abdominal-inguinal mammary glands were histologically examined. The incidence and multiplicity of DHs were similar between groups (STET, 90% and 3.9 ± 0.6 vs. age-matched controls, 80% and 3.0 ± 0.5). However, DCIS and IDC did not develop in STET rats, whereas DCIS (25% and 1.4 ± 0.2) and IDC (35% and 1.4 ± 0.3) developed in the age-matched controls. Immunoscores of estrogen and progesterone receptors and positive rate of proliferative cell nuclear antigen (PCNA) in DH were similar in both groups, while the positive rate of cyclin D1 was significantly reduced in the STET group (P < 0.05). Thus, STET blocked the progression from DH to DCIS in MNU-induced mammary carcinogenesis, and decreased expression of cyclin D1 may play an important role in the blockade of cell transition from DH to DCIS.

Sulforaphane inhibits the growth of KPL-1 human breast cancer cells in vitro and suppresses the growth and metastasis of orthotopically transplanted KPL-1 cells in female athymic mice.

The anticancer effects of sulforaphane (SFN), which is found in cruciferous vegetables, were studied on KPL-1 human breast cancer cells in vitro and in vivo. Cell proliferation in vitro was assessed by a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and tumor growth and metastasis in vivo were examined in orthotopically (right thoracic mammary fat pad) transplanted KPL-1 cells in female athymic BALB/c mice. The MTT assay showed that SFN directly inhibited KPL-1 cell growth in vitro (IC50 at 48 h, 19.1 µM; IC50 at 72 h, 17.8 µM). Athymic mice received a KPL-1 cell transplant, and SFN treatment (intraperitoneal injection of 25 or 50 mg/kg SFN) was started the next day. Mice received five injections each week during the 26-day experimental period (for a total of 20 injections). Compared with the SFN-untreated controls, SFN suppressed primary tumor growth. At the termination of the experiment, the final tumor volume was 686±94 mm3 for the control group, 516±70 mm3 (75% of control value) for the 25 mg/kg SFN group and 351±55 mm3 (51% of control value) for the 50 mg/kg SFN group. The final tumor weight was 571±69 mg in the control group, 416±63 mg (73% of the control value) in the 25 mg/kg SFN group and 338±56 mg (59% of the control value) in the 50 mg/kg SFN group. SFN caused a dose-dependent decrease in the proliferation ratio and an increase in the apoptotic ratio of the primary tumor cells. SFN treatment tended to reduce regional (axillary) lymph node metastasis. Treatment with 50 mg/kg SFN significantly inhibited KPL-1 cell growth in vivo by suppressing cell proliferation and inducing apoptosis, and it tended to reduce axillary lymph node metastasis of KPL-1 human breast cancer cell xenografts in female athymic mice.

Retinal degeneration induced in adult mice by a single intraperitoneal injection of N-ethyl-N-nitrosourea.

Seven-week-old female BALB/c mice received a single intraperitoneal injection of N-ethyl-N-nitrosourea (ENU) (50, 100, 200, 400, or 600 mg/kg), and retinal damage was evaluated after 7 days. Sequential morphological features of the retina and retinal apoptosis, as determined by the TUNEL assay, were analyzed 6, 12, 24, and 72 hr and 7 days after treatment with 600 mg/kg of ENU. Moreover, older mice (25 to 34 weeks of age) received an intraperitoneal injection of 600 mg/kg ENU and were sacrificed 7 days later. All animals were necropsied, and both eyes were examined histopathologically. Two of the 5 mice that received 600 mg/kg ENU died during the experimental period. Histopathologically, all mice that received 600 mg/kg of ENU experienced retinal degeneration characterized by the loss of photoreceptor cells (disappearance of the outer nuclear layer and photoreceptor layer) in both the central and peripheral retina within 7 days. One of 5 mice treated with 400 mg/kg ENU exhibited retinal damage that was restricted to the central retina. Older mice treated with 600 mg/kg ENU exhibited retinal damage that was similar to the retinal damage in younger mice. In the 600 mg/kg ENU-treated mice, TUNEL-positive photoreceptor cells peaked 72 hr after ENU treatment. Retinal thickness and the photoreceptor cell ratio in the central and peripheral retina were significantly decreased, and the retinal damage ratio was significantly increased 7 days after treatment. In conclusion, ENU induces retinal degeneration in adult mice that is characterized by photoreceptor cell apoptosis.

[A case of multi-drug resistant breast cancer with liver metastasis treated effectively by S-1 monotherapy].

We report a case of multi-drug-resistant breast cancer with liver metastases which completely responded and improved the quality of life (QOL)by S-1 monotherapy. The patient was a 53-year-old woman, who was diagnosed as breast cancer with invasive chest wall, cervical lymph node metastases, multiple bone metastases and bilateral pleural effusion[invasive ductal carcinoma, scirrhous type, ER(-), PgR(+), HER2(1+)]. After six courses of cyclophosphamide+epirubicin(CE)and weekly paclitaxel for 3 months, cervical lymph node metastasis was judged as a partial response(PR)and the bilateral pleural effusion disappeared. After chemotherapy, aromatase inhibitor (AI) was used. However, primary lesion and multiple bone metastases no change(NC). Following pass through AI+ oral anticancer drug combination chemotherapy and oral anticancer drug monotherapy, the therapy was changed to palliative, and she was referred to our hospital in January 2007. On arrival at the hospital, respiratory distress and bilateral pleural effusion had appeared, so it was an emergency admission. After removing the pleural effusion, pleurodesis was done and the symptoms disappeared. Although AI plus bisphosphonate therapy were started at hospital discharge, disease progression and fatigue appeared. In December 2007, we started S-1 monotherapy. S-1 was given orally at 80 mg/m2 for day 1-28 followed by a 2-week rest period, within a 6-week courses. Six months after treatment was started, multiple liver metastases disappeared and peritoneal effusion decreased. During the period of S-1 treatment, there were no serious adverse events, and treatment was possible without compromising QOL. This result suggested that S-1 treatment was a reasonable option for multi-drug-resistant breast cancer.

Autophagy inhibition enhances sulforaphane-induced apoptosis in human breast cancer cells.

AIM: Sulforaphane (SFN), which is present in cruciferous vegetables, induces growth arrest and/or cell death in cancer of various organs. The involvement of autophagy in the SFN-induced apoptotic death of human breast cancer cells was investigated. MATERIALS AND METHODS: Cell proliferation and viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and trypan blue exclusion assay. Flow cytometry, immunofluorescence, electron microscopy, and Western blot analysis were used for detection of apoptosis and autophagy, and the role of autophagy was assessed using autophagy inhibitors. RESULTS: SFN dose- and time-dependently retarded the growth and induced cell death in MCF-7 and MDA-MB-231 human breast cancer cells. In MDA-MB-231 cells, 30 µM SFN caused S and G2/M cell-cycle arrest associated with increased p21WAF1 and p27KIP1 levels and decreased cyclin A, cyclin B1 and CDC2 levels. Cell death was due to apoptosis with increased caspase-3 and lowered BCL-2 levels. In addition, the SFN-treated cells exhibited autophagy, as characterized by the appearance of autophagic vacuoles by electron microscopy, the accumulation of acidic vesicular organelles by flow cytometry, and the punctuate patterns of microtubule-associated protein 1 light chain 3 (LC3) by fluorescein microscopy. The levels of LC3-I and -II proteins (processed forms of LC3-I) and LC3 mRNA were increased. Treatment with autophagy inhibitor bafilomycin A1 (but not 3-methyladenine) with SFN significantly enhanced apoptosis, which was accompanied by increases in the level of BAX and the cleavage of caspase-3 and poly(ADP-ribose)polymerase (PARP)-1 and decreases in the mitochondrial membrane potential (ΔΨm). CONCLUSION: These results indicate a cytoprotective role of autophagy against SFN-induced apoptosis and that the combination of SFN treatment with autophagy inhibition may be a promising strategy for breast cancer control.

[A case of interstitial pneumonitis induced by S-1].

S-1, an oral fluoropyrimidine derivative, has been identified as an effective agent for the treatment of breast cancer. We present here a case of interstitial pneumonitis that occurred after S-1 treatment. A n 80-year-old woman was diagnosed with stage III infiltrating ductal carcinoma of the left breast and underwent a modified radical mastectomy in November 2001, followed by six courses of paclitaxel. In October 2008, metastatic disease was detected in her skeletal system. Therefore, S-1 chemotherapy was initiated (100 mg/body). Five days after starting S-1, she developed severe eruptions along with dyspnea. X-rays and CT scan showed diffuse ground glass shadow. Both her symptoms and the radiographic findings resolved dramatically after the start of high-dose corticosteroid therapy. Clinicians should be aware that S-1 has the potential to cause lung injury when it is included in chemotherapy.

Short-term pregnancy hormone treatment of N-methyl-N-nitrosourea-induced mammary carcinogenesis in relation to fatty acid composition of serum phospholipids in female Lewis rats.

AIM: Short-term oestrogen and progesterone treatment (STEPT) mimics the pregnancy hormone milieu. This study compared the development of N-methyl-N-nitrosourea (MNU)-induced mammary cancer in female Lewis rats that received STEPT in early or later life. MATERIALS AND METHODS: Rats in Groups 1 and 2 received a single intraperitoneal injection of 50 mg/kg MNU at 4 weeks old. Pellets containing 0.5 mg 17beta-estradiol and 32.5 mg progesterone (EP) were subcutaneously implanted in rats in Group 1 during 6-9 weeks old. Rats in Groups 3 and 4 received 50 mg/kg MNU at 22 weeks old and again at 23 weeks old. EP pellets were implanted in rats in Group 3 during 24-27 weeks old. At the time of EP removal and 8 weeks afterward, 4 randomly selected rats in each group were sacrificed for blood sampling. The fatty acid composition of serum phospholipids was measured by capillary gas chromatography. The remaining rats were sacrificed when they developed mammary tumours >or=1 cm in diameter or at the termination of the experiment, which was at 18 weeks old for Groups 1 and 2 and at 64 weeks old for Groups 3 and 4. Mammary cancer was histologically confirmed. RESULTS: Group 1 had a significantly suppressed incidence of mammary cancer compared to Group 2 (7% vs. 90%), whereas the cancer incidence in Group 3 was similar to that of Group 4 (50% vs. 56%). Rats in Group 1 had significantly smaller n-6/n-3 polyunsaturated fatty acid (PUFA) ratios and higher levels of docosahexaenoic acid (DHA) than those in Group 2 at the time of EP removal but not 8 weeks after EP removal. Neither the PUFA ratios nor the DHA levels differed between Groups 3 and 4 at any time. These data suggest that the age at which STEPT is administered is important, since its mammary cancer-suppressing potential was lost in aged animals. CONCLUSION: DHA and the n-6/n-3 PUFA ratio may play a crucial role in mammary cancer suppression by STEPT.

Solitary fibrous tumor of soft tissue: a case report and immunohistochemical study.

A case of solitary fibrous tumor (SFT) arising in the soft tissue of the left inguinal region is reported. A 57-year-old Japanese woman presented with a nonadherent, well-defined, oval mass that was 2 x 3 cm in diameter and located in the inguinal soft tissue. Microscopic evaluation showed proliferation of spindle-shaped, fibroblast-like cells by the coexistence of hypo- and hypercellular areas with mast cell infiltration separated by hemangiopericytoma-like blood vessels. Immunohistochemistry revealed strong expression of CD34 and CD99 in the fibroblast-like cells, supporting the diagnosis of SFT. Although the patient was free of symptoms such as hypoglycemia, immunoreactive insulin-like growth factor (IGF)-II was localized in the socalled Golgi area of the spindle-shaped cells. In conclusion, immunoreactive IGF-II was detected in SFT that was not associated with hypoglycemia.

Biphasic effect of short-term pregnancy hormone treatment on N-methyl-N-nitrosourea-induced mammary carcinogenesis in young and old rats.

This study examined the development of N-methyl-N-nitrosourea (MNU)-induced mammary carcinomas in young and old female Lewis rats following short-term treatment with estrogen and progesterone to mimic pregnancy. Rats exposed at 4 weeks of age to MNU were treated at 6 weeks of age (early MNU/young E/P treatment) or at 24 weeks of age (early MNU/old E/P treatment) with a 21-day slow-release pellet containing 0.5 mg 17ß-estradiol and 32.5 mg progesterone (E/P). Other rats were exposed to MNU at 22 and again at 23 weeks of age, and were treated with E/P at 24 weeks of age (late MNU/old E/P treatment). All experimental groups were compared with respective MNU-exposed age-matched E/P-untreated rats. Overt mammary carcinomas (≥1 cm in diameter) that were positive for hormone receptors were reduced in young E/P-treated rats, while hormone receptor-negative overt mammary carcinomas increased in old E/P-treated rats. The rate of development of small-sized mammary carcinoma (<1 cm in diameter) was similar in early MNU/young E/P-treated and late MNU/old E/P-treated groups, but higher in early MNU/old E/P-treated rats compared with respective E/P-untreated rats. At the termination of the experiment, normal mammary gland architecture had not been influenced by E/P treatment, although E/P treatment of older rats caused an increase in proliferating cell nuclear antigen (PCNA) labeling of the mammary tissue. Thus, the impact of short-term E/P treatment on MNU-induced rat mammary carcinogenesis is age-dependent and shows biphasic effects; the development of hormone-dependent overt mammary carcinomas was reduced in young rats but the development of hormone-independent overt mammary carcinomas increased in older rats. The enhanced outgrowth of hormone-independent overt mammary carcinomas by E/P treatment in old age is due to accelerated cell proliferation at the promotion/progression phase of mammary carcinogenesis. Age at short-term E/P treatment is crucial for breast cancer control.

A four node axillary sampling trial on breast cancer patients.

The surgical management of axillary lymph nodes in early breast cancer remains controversial, although several maneuvers have been developed such as axillary node clearance (ANC), four node axillary sampling (4NAS), and sentinel node biopsy. A total of 237 cases of primary breast cancer at stages I and II were studied prospectively to elucidate the correlation between 4NAS and ANC. All calculated values by 4NAS showed high sensitivity, specificity, and overall accuracy as follows in this study: 92.9%, 100% and 98.5% for stage I, and 93.8%, 100% and 98.3% for stage II. Likewise, the false negative (FN) rates were 7.1% for stage I, 6.3% for stage II, 6.7% for T1, 6.4% for T2, 7.4% for N0, 0% for N1, and 6.5% for all cases. These rates were very low, although 7.4% for N0 and 0% for N1 were quite clearly different. This implies that all FN cases were N0, and were caused by micrometastases with normal consistency and size. 4NAS may be as accurate a procedure as ANC in assessing axillary nodal stage.