Impact of background parenchymal enhancement levels on the diagnosis of contrast-enhanced digital mammography in evaluations of breast cancer: comparison with contrast-enhanced breast MRI.

PURPOSE: To compare the diagnostic performances of contrast-enhanced digital mammography (CEDM) and breast MRI in evaluations of breast cancer, with a focus on the impact of background parenchymal enhancement (BPE) levels. METHODS: The present study included women who underwent CEDM and breast MRI to evaluate the disease extent of breast cancer between January 2018 and December 2019. Readers judged BPE levels (minimal-mild or moderate-marked) on CEDM, and were asked to assign findings suggesting malignancy using the following criteria: (1) enhancement other than BPE and (2) BI-RADS 4/5 calcifications without enhancement. On MRI, BI-RADS 3 and BI-RADS 4/5 lesions were evaluated as benign and malignant, respectively. The diagnostic performances of CEDM and MRI were compared separately between women with minimal-mild BPE and those with moderate-marked BPE. RESULTS: Sixty-nine patients comprising 43 postmenopausal and 26 premenopausal women were included in the present study. In total, 195 lesions (94 malignant and 101 benign) were identified. The sensitivity and specificity of CEDM for the diagnosis of all lesions were 90.8 and 91.5% with minimal-mild BPE and 79.3 and 76.2% with moderate-marked BPE, respectively. The sensitivity and specificity of MRI were 90.0% and 71.0% with minimal-mild BPE and 87.5% and 78.1% with moderate-marked BPE, respectively. The accuracy of CEDM was significantly superior to that of MRI in women with minimal-mild BPE on both CEDM and MRI (p = 0.002). Regarding the negative impact of a correct diagnosis on CEDM, the odds ratio of "moderate-marked BPE" was 0.382. CONCLUSION: In patients with minimal-mild BPE, the diagnostic performance of CEDM was superior to that of MRI.

The association between MRI findings and breast cancer subtypes: focused on the combination patterns on diffusion-weighted and T2-weighted images.

PURPOSE: To assess morphology on diffusion-weighted imaging (DWI) and intratumoral signal intensity (SI) on T2-weighted images (T2WI) of breast carcinomas, and to evaluate the association between the combined DWI and T2WI findings and breast cancer subtypes. METHODS: Two hundred and eighty breast cancer patients who underwent breast MRI prior to therapy were included in this retrospective study. All had invasive carcinomas, which were classified into five subtypes: Luminal A-like (n = 149), Luminal B-like (n = 63), Hormone receptor-positive HER2 (n = 31), Hormone receptor-negative HER2 (n = 13), or Triple-negative (TN) (n = 24). Based on the morphology on DWI, the tumors were classified into two patterns: DWI-homogeneous or DWI-heterogeneous. If DWI-heterogeneous, an assessment of intratumoral SI on T2WI was performed: tumors with intratumoral high/low SI on T2WI were classified as Hete-H/Hete-L, respectively. The associations between (1) the morphological patterns on DWI and the five subtypes, and (2) the intratumoral SI patterns on T2WI and the five subtypes in DWI-heterogeneous were evaluated. RESULTS: There was a significant association between (1) the morphological patterns on DWI and the five subtypes (p < 0.0001), and (2) the intratumoral SI patterns on T2WI and the five subtypes in DWI-heterogeneous (p < 0.0001). DWI-homogeneous was dominant in Luminal A-like (67.1%), and Hete-H was dominant in TN type (75%). Hete-H, suggesting the presence of intratumoral necrosis, included high proliferative and/or aggressive subtypes more frequently (80%) than Hete-L, suggesting the presence of fibrotic focus. Fibrotic focus was seen more commonly in the luminal subtypes. CONCLUSION: The combined findings on DWI and T2WI revealed breast carcinomas that were associated with particular subtypes.

[A Case of Alcoholic Liver Disease Presenting as Prominent Accumulation of Ascites Associated with Liver Damage Due to CapeOX].

A 75-year-old man with rectal cancer had consumed an average of6 6 g of alcohol per day for 47 years. However, his liver function was within normal limits and his Child-Pugh classification was A before initiation of therapy. He underwent neoadjuvant chemoradiation and a low anterior resection. The patient then received CapeOX as an adjuvant therapy. During the fourth cycle of CapeOX, computed tomography(CT)showed massive ascites. The chemotherapy was discontinued and treatment including a diuretic agent was initiated. The ascites gradually decreased and 8 months after the discontinuation of CapeOX, CT showed neither the presence ofascites nor recurrence ofthe cancer or metastasis. When a patient has a history ofexcessive alcohol intake, even iftest results for liver function are within normal limits, we should be aware ofthe hepatic toxicity ofCapeOX.

[A Case of Squamous Cell Carcinoma of the Esophagus with Achalasia -- Conversion from Chemoradiotherapy to Surgery].

The patient was a 67-year-old woman with achalasia and squamous cell carcinoma(SCC)of the esophagus. She presented with a difficulty in swallowing. The cancer was on the surface of the esophagus. The patient initially received systemic chemotherapy with 5-FU and cisplatin, and radiation therapy. The difficulty in swallowing persisted due to insufficiency of radiation treatment caused by achalasia. Therefore, we shifted the treatment plan from chemoradiotherapy to surgery. Endoscopic examination performed before surgery showed that there was no obvious cancer in the esophagus. We resected the esophagus routinely. On the specimen, no cancer cells were detected upon macroscopic and microscopic examinations; metastasis was not detected in the lymph node. Achalasia is a recognized risk factor for esophageal SCC. In the treatment of superficial SCC, no difference of therapeutic effect was observed between surgery and chemoradiation. However, for the treatment of certain cases of SCC with achalasia, including the treatment of achalasia itself, surgery can be the preferred option of treatment.

[Clinical Response of Metastatic Colon Cancer to Chemotherapy with S-1 and Oxaliplatin - A Case Report].

Chemotherapy with S-1 and oxaliplatin is a new treatment for metastatic colorectal cancer. We present the first case of S-1, oxaliplatin, and bevacizumab therapy in our hospital. The patient was a 69-year-old woman with ascending colon cancer and multiple lung and liver metastases. She tended to suffer from constipation; stenoses at the cecum and colon cancer were detected by colon fiberscopy. Following surgical resection of the primary tumor, the patient received systemic chemotherapy with S-1, oxaliplatin, and bevacizumab. Following chemotherapy, CT showed no cancer in the lung and cancer reduction in the liver or dissemination. The patient had diarrhea and no appetite at first, so we reduced the oxaliplatin dose by 80%. After reduction of the oxaliplatin dose, we could treat the patient with S-1 and oxaliplatin continuously with no toxicity. S-1 and oxaliplatin chemotherapy is cost-effective, and has less toxicity than other chemotherapies, if proper measures are taken. It seemed to have a non-inferior response rate and disease control compared to other chemotherapies, such as FOLFOX. Thus, this chemotherapy is a valid choice for metastatic colorectal cancer.

[A case of Complete Response(CR)to combination therapy of S-1 and Gemcitabine(GEM)for unresectable pancreatic cancer].

Pancreatic cancer is among the most lethal of all digestive cancers, and it is very difficult to obtain long-term survival of unresectable cases. This case report reveals that combination chemotherapy with S-1/gemcitabine(GEM)was very effective for a patient with unresectable pancreatic body cancer. The patient was a 72-year-old female(Stage IVb). They were administered S-1 80mg/day for 2 weeks and GEM 1, 000mg/m2 on day 8 and 15 followed by a 2-week recovery period. After finishing the 2 courses, there was a notable reduction in tumor size. After finishing 9 courses, the tumor could not be observed and it was judged it to be CR. Currently, at 1 year and 4 months from the initial diagnosis, there is no recurrence of tumor, and the general condition of the patient is very good. Combination chemotherapy with S-1/GEM may be useful to improve the prognosis for unresectable pancreatic cancer.

Effects of idiotypic human anti-mouse antibody against in vitro binding and antitumor activity of a monoclonal antibody-drug conjugate.

BACKGROUND/AIMS: Because the HAMA (human anti-mouse antibody) response following administration of murine monoclonal antibodies represents mainly isotypic HAMA production, idiotypic HAMA responses have not been thoroughly analyzed. METHODOLOGY: In the present study we examined the effect of idiotypic HAMA that arose in patients who had repeatedly received murine monoclonal antibody conjugated to an anticancer drug against in vitro binding and antitumor activity of the conjugate. HAMA that had developed after administration of tumor-specific murine monoclonal antibody A7 conjugated with neocarzinostatin were measured in patient serum. The inhibitory effect of HAMA on tumor binding and antitumor activity of the A7-neocarzinostatin conjugate was examined in cultures of human colonic carcinoma cells. RESULTS: The serum concentration of idiotypic HAMA in patients administered A7-neocarzinostatin was significantly higher than that in a control group. Binding activity and antitumor activity of A7-neocarzinostatin against target cells was reduced in the presence of sera containing HAMA. CONCLUSIONS: Repeated use of A7-neocarzinostatin can be expected to show less antitumor effect than the first use of the conjugate.

Decreased production of anti-mouse antibody after administration of human/mouse chimeric monoclonal antibody-neocarzinostatin conjugate to human.

BACKGROUND/AIMS: One problem that has been encountered with the use of murine Mabs is the development of a human anti-mouse antibody (HAMA) which lead to serious problems such as anaphylaxis. In order to evaluate the decreased HAMA production after administration of Fab fragments of chimeric monoclonal antibody, Fab fragments of chimeric Mab A7 (chA7Fab) was administered as neocarzinostatin (NCS) conjugate to seven patients with colonic cancer. METHODOLOGY: The in vivo pharmacokinetics of chA7Fab and HAMA production was examined. These patients received an infusion of 4,000 U: dose of NCS (18 mg: dose of chA7Fab). RESULTS: The plasma disappearance curves showed that chA7Fab-NCS was more rapidly cleared than A7-NCS. The chA7Fab-NCS did not elicit of HAMA in two of seven evaluable patients. The chA7Fab-NCS NCS elicited low levels of HAMA in five of seven evaluable patients. In contrast, A7-NCS elicited high levels of HAMA in all patients tested. Anti-isotype HAMA was not seen in seven evaluable patients tested with chA7Fab-NCS, while A7-NCS elicited high levels in all patients tested. CONCLUSIONS: This study demonstrates the reduced immunogenicity and shorter clearance time of chA7Fab-NCS compared to A7-NCS.