Search

Background: For patients (pts) with HER2 positive (HER2+) breast cancer, the achievement of pathological complete response (pCR) after neoadjuvant chemotherapy is regarded as a surrogate endpoint of prognosis, however, the exact definition of pCR and its prognostic impact on survival in HER2+ breast cancer subtypes when stratified by hormonal receptor (HR) status is uncertain. Methods: We retrospectively investigated 163 HER2+ pts who received neoadjuvant chemotherapy in Hyogo Cancer Center between 2003 and 2010. HR+ was defined as estrogen or progesterone receptor positive. pCR at surgery was defined as no evidence of invasive and noninvasive residual in the breast or axillary nodes (ypT0 ypN0), no evidence of invasive residual in the breast or axillary nodes; noninvasive breast residuals allowed (ypT0/is ypN0), or no evidence of invasive residual in the breast; noninvasive breast residuals and infiltrated lymph nodes allowed (ypT0/is ypN0/+). Logistic regression analysis and logrank test were performed to identify HR status as a predictor of pCR and its prognostic significance on recurrence-free survival (RFS). Results: The median age at diagnosis was 55 years (range, 25-84) and the median follow- up period was 61 months (range, 15-104). Stage I, IIA, IIB, III were 4, 57, 56, 46 pts, HER2+HR+ and HER2+HR- were 89 and 74 pts, respectively. The rates of pts receiving anthracycline, taxane and trastuzumab were 66, 82 and 51%, respectively. After surgery, 98% of HER2+HR+ pts received hormonal therapy. Five-year RFS rates were significantly higher in HER2+HR- pts with pCR compared to non-pCR, however, which were similar in HER2+HR+ pts with pCR compared to non-pCR regardless of the pCR definitions. In logistic regression analysis, significantly fewer HER2+HR+ pts achieved pCR compared to HER2+HR- pts regardless of the pCR definitions. Conclusions: HER2+HR+ breast cancer pts had lower achievement rate of pCR, which was less prognostic compared to that in HER2+HR- pts regardless of pCR definitions. pCR is a suitable surrogate end point for HER2+HR- pts but not for HER2+HR+ pts in clinical trial settings. [ABSTRACT FROM AUTHOR]

Background: Many recent clinical trials conducted in Western populations suggest that obesity is a prognostic factor after primary treatment in postmenopausal breast cancer patients. However, the incidence of obesity differs substantially between Asian and Western breast cancer patients. Moreover, few studies have reported the relationship between body mass index (BMI) and postsurgical prognosis in Asian breast cancer patients. A previous retrospective analysis of Japanese populations revealed that obesity might be a prognostic risk factor in Japanese breast cancer patients. Methods: We retrospectively analyzed BMI and clinical outcomes after primary treatment in Japanese breast cancer patients of Hanshin and Hokkaido areas. We reviewed the clinical data (height, weight, BMI, estrogen receptor [ER] status, progesterone receptor status [PgR], human epidermal growth factor receptor 2 [HER2] status, and outcome) of 1,222 primary breast cancer patients with clinical stage I-III disease who were operated on between Jan 2004 and Dec 2005 at Kobe Breast Cancer Oncology Group (KBCOG) and Hokkaido Cancer Center (median follow-up period, 74 months). The patients were categorized into 4 groups: underweight (BMI, <18.5 kg/m²), normal (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²), and obesity (>30.0 kg/m²). Patient characteristics, excluding age and menopausal status, were well-balanced across groups. The correlations of BMI with disease-free survival (DFS) and overall survival (OS) were analyzed using the Cox hazards model. Results: The normal, underweight, overweight, and obesity groups contained 832 (68.1%), 92 (7.5%), 253 (20.7%), and 45 (3.7%) patients, respectively. Breast cancer recurred in 184 patients (15.0%); 75 patients died due to breast cancer recurrence, 29 died of other diseases, and 6 died of unknown causes. The univariate hazard ratio (HR) values for disease-free survival and overall survival in the overweight group were significantly lower than those in the normal group. However, there were no statistical significant differences among four groups by the multivariate analysis. We added subgroup analysis with classifications by ER and PgR status to speculate the cause for these unexpected results. Although there were no statistically significant differences, HRs for DFS and OS in the obesity group were higher than those in the normal group among ER- and/or PgR-positive patients. However, HRs for DFS and OS tended to be higher in the underweight groups and lower in the overweight groups in ER- and PgR-negative populations. Conclusions: The incidence of obesity in the Japanese population is much lower than that in the Western population. Although results of this study were slightly different from recent findings, obesity might be a risk factor for DFS and OS in ER-positive Japanese breast cancer patients, similar to that in Western countries. In underweight patients, ER- and PgR-negative status might indicate poor prognosis. However, this study was a retrospective analysis of a limited, heterogeneous patient group. A large-scale cohort study in the Japanese population is, therefore, recommended. [ABSTRACT FROM AUTHOR]

Purpose: The concept of non-mass abnormalities of the breast has been employed in Japan for approximately 20 years. Although B-mode findings are classified as non-mass abnormalities, the usefulness of adding color Doppler ultrasonography (US) and strain elastography to B-mode US is unclear. Therefore, we conducted a multicenter study (JABTS BC-07) to establish the diagnostic criteria for breast US, including color Doppler and elastography, for non-mass abnormalities of the breast and verify their diagnostic usefulness., Methods: We registered US images of non-mass abnormalities of the breast and their clinical and histopathological data from 13 institutions (202 malignant and 183 benign non-mass lesions). Furthermore, we evaluated the centralized image interpretation usefulness of the diagnostic criteria for B-mode and color Doppler US, as well as the sensitivity and specificity when color Doppler US and elastography were added to B-mode US., Results: Echogenic foci in the mammary gland (odds ratio 3.45, 95% confidence interval [CI] 1.92-6.19, p < 0.0001) and the configuration of internal solid components of the ducts (odds ratio 0.056, 95% CI 0.005-0.591, p < 0.0165) significantly differentiated benign and malignant non-mass abnormalities. The sensitivity of B-mode alone (83.7%) was significantly improved by adding color Doppler US (93.1%) (p = 0.0004); however, adding color Doppler US and elastography to B-mode US made no significant difference in either sensitivity or specificity., Conclusion: Although adding color Doppler US and elastography to B-mode US improved sensitivity, the diagnostic significance was limited. Therefore, a comprehensive diagnostic method comprising mammography and magnetic resonance imaging is warranted., (© 2024. The Author(s).)

This article provides updates to readers based on the newly published Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2022 Edition. These guidelines incorporate the latest evaluation of evidence from studies of diagnostic accuracy. For each clinical question, outcomes for benefits and harms were established, and qualitative or quantitative systematic reviews were conducted. Recommendations were determined through voting by a multidisciplinary group, and guidelines were documented to facilitate shared decision-making among patients and medical professionals. The guidelines address screening, surveillance, and pre- and postoperative diagnosis of breast cancer. In an environment that demands an integrated approach, decisions are needed on how to utilize modalities, such as mammography, ultrasound, MRI, and PET/CT. Additionally, it is vital to understand the appropriate use of new technologies, such as tomosynthesis, elastography, and contrast-enhanced ultrasound, and to consider how best to adapt these methods for individual patients., (© 2023. The Author(s).)

The usefulness of color Doppler ultrasound (CD) in distinguishing between benign and malignant breast lesions remains controversial. Our prior study, the Japan Association of Breast and Thyroid Sonology (JABTS) BC-04 study (malignant: 839, benign: 569), found CD was useful in breast cancer diagnosis, and we developed CD diagnostic criteria. The first aim of the current study (the CD-CONFIRM study) was to evaluate the usefulness of the CD diagnostic criteria. The second aim was to evaluate the relationship between CD and elastography. We evaluated ultrasound images of breast masses from 13 institutions (malignant: 639, benign: 712). While the sensitivity of B-mode alone was very high and was not significantly improved with CD, the specificity was significantly improved with CD (61.2%-69.2%, p < 0.0001). Furthermore, the specificity of the combination of B-mode and CD improved significantly with the addition of elastography (72.8%-79.0%, p < 0.0001). This study found that the CD criteria are useful, and CD and elastography are independent., Competing Interests: Conflict of interest disclosure The authors have no conflicts of interest to declare. This research was supported by the Research and Development Committee Program of the Japan Society of Ultrasonics in Medicine and the Japan Association of Breast and Thyroid Sonology., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background/aim: S-1, a 5-fluorouracil(5-FU) oral anti-cancer drug, has been traditionally used with a schedule of 4-week oral administration followed by 2-week rest for breast cancer treatment. We, herein, aimed to investigate the clinical efficacy and safety of a schedule of 2-week oral administration followed by 1-week rest for patients with metastatic breast cancer., Patients and Methods: We enrolled patients with HER2-negative metastatic breast cancer who had not received prior chemotherapy. S-1 was administered consecutively for 2-weeks followed by a 1-week rest., Results: Between September 1, 2013 and August 31, 2016, 32 patients were enrolled. The median follow-up time was 32.1 months. The median progression-free survival (PFS) was 9.4 months. Overall survival (OS) was 41.0 months, time to treatment failure (TTF) was 7.8 months, response rate (RR) was 31.3%, and disease control rate (DCR) was 78.1%. The incidence of grade 3 side-effects was not high., Conclusion: The 3-week schedule of S-1 can be considered useful as a treatment for patients with metastatic breast cancer, helping in maintaining a high quality of life., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Purpose: Breast ultrasound has been widely used as an essential examination for diagnosing breast cancer. However, standardized diagnostic criteria are as yet lacking. This study aimed to develop a simple diagnostic flowchart for beginners learning breast ultrasonography. The diagnostic flowchart was developed based on the recall criteria widely used in Japan., Methods: We conducted a multicenter study to examine recall criteria usefulness in the diagnostic phase of breast disease. Women with ultrasound-visible breast masses who underwent B-mode breast ultrasound examination were recruited from 22 hospitals in Japan between September 2009 and January 2010. B-mode images were evaluated by members of the centralized image interpretation committee. We developed the new diagnostic flowchart based on the results. The usefulness of the diagnostic flowchart was assessed by employing datasets from the current study and another study which we conducted (BC-04 study)., Results: We evaluated 1045 solid masses (malignant: 495, benign: 550). Multivariate analysis showed that shape, margin, echogenic halo, interruption of the mammary gland interface, and depth width ratio were significant findings for distinguishing between benign and malignant masses. We modified the recall criteria and developed our novel diagnostic flowchart using these findings. The sensitivity and specificity of the new flowchart (current study: 0.97, 0.45; BC-04 study dataset: 0.95, 0.45) were similar to those of experts (current study: 0.96, 0.54; BC-04 study dataset: 0.98, 0.38)., Conclusion: We developed a simple diagnostic flowchart for breast ultrasound. This flowchart is anticipated to be applicable to educating beginners learning breast ultrasound.

This article updates readers as to what is new in the Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast cancer screening issues are covered, including matters of breast density and possible supplemental modalities, along with appropriate pre-operative/follow-up diagnostic breast imaging tests. Up-to-date clinical practice guidelines for breast cancer screening and diagnosis should help to provide patients and clinicians with not only evidence-based breast imaging options, but also accurate and balanced information about the benefits and harms of intervention, which ultimately enables shared decision making about imaging test plans.

Purpose: Although the number of ductal carcinoma in situ (DCIS) cases has increased with the spread of breast cancer screening in Japan, there are very few reports that summarize ultrasound image features of DCIS. The Japan Association of Breast and Thyroid Sonology (JABTS) investigated the incidence of DCIS with masses and non-mass abnormalities and the characteristics of US images in a retrospective, multicenter, observational study (JABTS BC-02 study). The purpose of this report is to clarify the proportion of DCIS with abnormalities of the ducts with each ultrasound finding and the characteristics of US images., Methods: The JABTS BC-02 study population was comprised of patients who were examined by ultrasonography, underwent surgery, and were histopathologically diagnosed with DCIS at each study site between January 2008 and December 2012. The US images of DCIS and pathology and clinical information were retrospectively collected from 16 institutions in Japan. The US images were evaluated by 22 experts on the Central Image Interpretation Committee of JABTS., Results: Abnormalities of the ducts were noted in 78 (10.5%) of 705 US images of DCIS. Of the 78 cases, the distribution of abnormalities of the ducts was focal or segmental. The second characteristic was the presence of internal echoes in dilated ducts. All cases were accompanied by intraductal solid echoes, and 40 cases (51.3%) were accompanied by echogenic foci. In addition, intraductal solid echoes were continuous or multiple in 72 cases (92.4%), and the shape of the solid echoes was broad-based and/or irregular in 62 cases (79.5%)., Conclusion: DCIS cases with duct abnormalities on ultrasound were investigated in this study. The important characteristics were as follows: (1) the distribution of ductal dilatation was focal or segmental, (2) solid parts were present in the dilated ducts, (3) the distribution of internal echoes was continuous or multiple, (4) the shape of solid echoes was broad-based and/or irregular, and (5) internal echoes were sometimes accompanied by echogenic foci. Accurate evaluation of these findings may be useful for diagnosing DCIS. Although the duct abnormalities are included in "ASSOCIATED FEATURES" in ACR BI-RADS ATLAS (USA), we emphasize that this concept is very important for understanding US characteristics of DCIS.

Background/aim: Dose-dense doxorubicin and cyclophosphamide (ddAC) followed by dose-dense paclitaxel (ddP) (ddAC-P) has improved disease-free survival of patients with breast cancer. The aim of this study was to evaluate the safety and relative dose intensity (RDI) of ddAC-P administered together with pegfilgrastim., Patients and Methods: Between May 2015 and Aug 2017, 44 patients were retrospectively reviewed; they were administered 4 cycles of ddAC, followed by 4 cycles of ddP. Pegfilgrastim (3.6 mg) was administered in every cycle., Results: The mean RDIs for ddAC-P, ddAC, and ddP were 95.0%, 94.5%, and 93.3%, respectively. The prevalence of high RDIs (≥85%) for ddAC-P, ddAC, and ddP was 90.9%, 84.1%, and 88.6%, respectively. Seven of the 10 patients with low RDIs experienced grade 1 or 2 fever., Conclusion: DdAC-P administered together with pegfilgrastim (3.6 mg) appears to be feasible and maintains RDI in most of Japanese patients with breast cancer. Rapid evaluation and proper management of fever may prevent low RDI., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: To compare patient preferences and acute adverse events of hypofractionated (HF) and conventionally fractionated (CF) whole-breast irradiation (WBI) after breast-conserving surgery in our institution., Methods: We conducted a patient preference study comparing CF-WBI (50 Gy/25 fractions) and HF-WBI (41.6 Gy/16 fractions) after breast-conserving surgery. Eligible patients selected either type of fractionation following an explanation from the radiation oncologist. In this report, we analyzed the selection rate and acute toxicities., Results: Between June 2009 and December 2013, 348 patients (349 breasts) were identified as eligible for the study. Among them, 259 patients (260 breasts [74.5%]) selected CF-WBI and 89 patients (89 breasts [25.5%]) selected HF-WBI. Factors significantly associated with the selection of HF-WBI were older age (P = 0.028) and no adjuvant chemotherapy (P = 0.041). Regarding acute adverse events, Grade 2 (G2) or higher radiation dermatitis was less frequently observed in HF-WBI than in CF-WBI (13.8% vs. 29.4%; P = 0.004). In addition, G2 or higher breast pain was only observed in the CF-WBI group (6.9%; P = 0.012). There were no significant differences in the presence of fatigue, wound pain or radiation pneumonitis of G2 or higher between the groups., Conclusions: In this study, in which patients themselves selected the irradiation method, more patients tended to select CF-WBI. The frequency of G2 or higher dermatitis and breast pain was significantly lower in the HF-WBI group than in the CF-WBI group. Our results support the evidence for recommending HF-WBI after breast-conserving surgery while presenting aspects of patient preferences., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The use of color Doppler ultrasound (CD) for distinguishing between benign and malignant breast lesions remains controversial. This study (JABTS BC-04 study) was aimed at confirming the usefulness of our CD diagnostic criteria. We evaluated ultrasound images of 1408 solid breast masses from 16 institutions in Japan (malignant: 839, benign: 569). Multivariate analysis indicated that vascularity (amount of blood flow), vascular flow pattern ("surrounding marginal flow" or "penetrating flow") and the incident angle of penetrating flow were significant findings for distinguishing between benign and malignant lesions. However, the sensitivity and specificity of B-mode alone did not improve significantly with CD addition (97.6% → 97.9%, 38.3% → 41.5%, respectively). We explored the causes of these negative results and found that age should have been considered when evaluating vascularity. Simulation experiments suggested that specificity is significantly improved when age is taken into consideration (38.3% → 46.0%, p < 0.001) and we thereby improved our diagnostic criteria., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

[This corrects the article on p. 179 in vol. 4, PMID: 26005649.].

The Japan Association of Breast and Thyroid Sonology (JABTS) proposed, in 2003, a conceptual classification system for non-mass abnormalities to be applied in addition to the conventional concept of masses, to facilitate detecting ductal carcinoma in situ (DCIS) lesions. The aim of this study was to confirm the utility of this system and to clarify the distribution of these findings in DCIS lesions. Data on 705 surgically treated DCIS lesions from 16 institutions in Japan were retrospectively reviewed. All 705 DCIS lesions could be classified according to the JABTS classification system. The most frequent findings were hypo-echoic areas in the mammary gland (48.6%), followed by solid masses (28.0%) and duct abnormalities (10.2%) or mixed masses (8.1%). Distortion (1.3%), clustered microcysts (1.4%) and echogenic foci without a hypo-echoic area (2.5%) were uncommon. These results suggest that the concept of non-mass abnormalities is useful in detecting DCIS lesions., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Endocrine treatment-related adverse events have a strong impact on patients' quality of life and sometimes result in treatment discontinuation. Since joint symptoms are the most frequently recognized side effect of aromatase inhibitors, evaluation of associated risk factors may yield significant findings., Patients and Methods: A total of 391 postmenopausal Japanese women with estrogen receptor-positive breast cancer and treated with adjuvant anastrozole were enrolled from 28 centers for assessment of patient-reported outcomes (PROs) in this prospective cohort study (SAVS-JP, UMIN000002455). Patients completed the self-report questionnaire at baseline and after 3, 6, 9, and 12 months of treatment for evaluation of frequency of treatment-related joint symptoms (arthralgia, decrease in range of joint motion, and joint stiffness)., Results: We obtained PROs from 362 patients (92.6 %) at baseline and at one or more subsequent points. New or worsening from baseline of joint symptoms were reported by 260 patients (71.8 %). More than 90 % of the symptoms were mild or moderate and nearly 80 % had occurred by 6 months. Multivariate analysis showed that a short time span after menopause [odds ratio (OR) 0.95, 95 % confidence interval (CI) 0.90-0.99; P = 0.02] and adjuvant chemotherapy (OR 2.29, 95 % CI 1.06-4.95; P = 0.03) were significant independent risk factors for joint symptoms. No significant relationships between body mass index (BMI) and joint symptoms were identified. Eighteen patients discontinued treatment during the 1st year and eight of them reported joint symptoms., Conclusion: Taking into consideration that PROs may yield higher prevalence rates than physician ratings for symptoms published in pivotal clinical trials, we found that a short time span after menopause and use of adjuvant chemotherapy, but not high BMI, were significantly associated with joint symptoms. These findings might prove useful for counseling before initiating treatment with adjuvant aromatase inhibitors in postmenopausal Japanese women.

Background: Immediate volume replacement using a free dermal fat graft (FDFG) has been proven safe with early postoperative benefits. The aims of the present study were to clarify adequate indications and risk factors associated with operative morbidity., Patients and Methods: A multi-institutional analysis of partial mastectomy with immediate volume replacement with FDFG was undertaken in 14 hospitals specializing in breast cancer treatment. Clinical and oncological variables were analyzed to identify factors associated with postoperative complications., Results: A total of 262 cases were analyzed. Considering the observation period and overlap of patients, 13 (5.4%) out of 242 patients had complications within 1 month of surgery while 7 (4.6%) out of 151 patients developed complications 1-12 months after surgery. Two hundred and eleven out of 242 patients were statistically examined using a multivariate analysis, which revealed that the weight of resected breast tissue, size of implanted FDFG (cranio-caudal length), and weight of implanted FDFG were associated with a higher likelihood of postoperative complications., Conclusions: Immediate breast volume replacement using a FDFG after breast cancer surgery should be done for selected patients with breast cancer to avoid postoperative complications. The prospective and larger investigations are warranted for the establishment of appropriate guidelines.

Objective: For patients with HER2-positive breast cancer, the prognostic impact of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) is unclear when stratified by hormonal receptor (HR) status; however, the impact of pCR on survival when stratified by hormonal receptor (HR) status is uncertain., Patients and Methods: This multicenter retrospective study investigated the predictors of pCR and its prognostic value in Japanese patients 366 HER2-positive breast cancer who received NAC. pCR was defined as no invasive residual tumor in the breast or axilla., Results: Median follow-up was 55 months. Multivariate analysis revealed that HR status (OR, 0.37; p < 0.001) was one of the independent predictors of pCR. Five-year recurrence-free survival was higher in HR-negative patients with pCR (93%) than in those without pCR (68%), and pCR was independently prognostic (hazard ratio, 0.32; p = 0.005). However, 5-year recurrence-free survival was not different between HR-positive patients with pCR (94%) and those without pCR (84%), and pCR was not significantly prognostic (hazard ratio, 0.53; p = 0.39). In addition, 5-year overall survivals were high and similar (97% in pCR, 94% in non-pCR). Among 204 patients treated with neoadjuvant trastuzumab, pCR was not significantly prognostic in the HR-positive group (hazard ratio, 0.63; p = 0.56)., Conclusion: Our study suggested that the HER2-positive HR-positive patients had a good prognosis despite the lower achievement rate of pCR, whose prognostic impact was smaller than that in the HER2-positive HR-negative patients. The treatment strategy for HER2-positive breast cancer can be stratified by HR status., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The patient was a 53-year-old woman with a large left breast tumor. Triple-negative breast cancer with bilateral axillary lymph-node metastasis and bone metastasis was diagnosed. The primary treatment consisted of chemotherapy with a combination of paclitaxel(PTX 80mg/m 2)and bevacizumab(Bev 10 mg/kg). After chemotherapy, the tumor shrunk and showed an obvious decrease in size, eventually disappearing. After therapy, an ulcer was detected on the left breast, and mastectomy and axillary lymph node dissection were performed. The patient's postoperative course was uneventful and she has been receiving chemotherapy at our outpatient clinic. Thus, combination therapy with PTX and Bev may be useful for the local control of advanced breast cancer.

Background: Sentinel lymph node biopsy (SLNB) is a standard surgical procedure for patients with early breast cancer. The combination of radioisotope (RI) and dye staining is the most accurate method for identification of sentinel lymph nodes (SLN). However, institutions without RI centers perform SLNB by blue dye alone. The identification rate with the dye method alone is inferior to the RI combination method. In our institution, the identification rate of SLNBs by the dye method alone was 95%. So we started this study of SLNB using computed tomographic lymphography (CTLG)., Patients and Methods: Three hundred twenty-four patients with primary breast cancer and no clinical evidence of lymph node metastasis were studied. Identification of SLN was performed by CTLG and the dye-staining method. The identification rate of SLNs was analyzed for relation with the clinicopathological findings., Results: The SLN identification rate was 98.5% with CTLG and 98.8% when combined with the dye-staining method. The identification rate with CTLG was significantly lower in the initial cases. CTLG identified the SLNs in all cases 6 months after its induction. Multi-route multi-SLN patterns, in which SLNs were easily missed by the dye method, were detected in 9.6% of the patients. There was a significant difference in the SLN metastasis rates; partial enhancement of the SLN with CTLG had the consequence that the metastasis-positive rate was high., Conclusion: The SLN identification rate was improved by combining the dye-staining method and CTLG. CTLG has a superior spatial resolution activity for detecting SLNs precisely; making CTLG available for the prediction of metastases has been suggested. It is possible to perform SLNB with high accuracy by using CTLG in the institutions that do not have RI.

Purpose: The purpose of this retrospective study was to evaluate the diagnostic performance of positron emission tomography/computed tomography (PET/CT) with fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose (FDG) in comparison with that of ultrasonography and contrast-enhanced computed tomography (CT) in detecting axillary lymph node metastasis in patients with breast cancer., Materials and Methods: Fifty patients with invasive breast cancer were recruited. They had received no neoadjuvant chemotherapy and underwent PET/CT, ultrasonography and contrast-enhanced CT before mastectomy. The clinical stage was I in 34 patients, II in 15 patients, and III in one patient. The images of these modalities were interpreted in usual practice before surgery and the diagnostic reports were reviewed for analysis. Sensitivity, specificity, positive predictive value, and negative predictive value of each modality were obtained taking histopathological results of axillary lymph node dissection or sentinel lymph node biopsy as the reference standard., Results: Axillary lymph node metastasis was confirmed in 15 of 50 patients by histopathological studies. PET/CT identified lymph node metastasis in three of these 15 patients. The overall sensitivity and specificity, positive predictive value, and negative predictive value of PET/CT in the diagnosis of axillary lymph node metastasis were 20, 97, 75, and 74%, and those of ultrasonography were 33, 94, 71, and 77% and those of contrast-enhanced CT were 27, 97, 80, and 76%, respectively., Conclusions: PET/CT showed poor sensitivity and high specificity in the detection of axillary lymph node metastasis of breast cancer. Diagnostic performance of PET/CT was not superior to that of ultrasonography and contrast-enhanced CT.

Objective: The purpose of this study was to describe the MRI features of the pure and mixed forms of mucinous carcinoma of the breast and the histopathologic correlation., Materials and Methods: Seventeen pure and three mixed mucinous tumors of the breast were examined with T2-weighted MRI and triple-phase dynamic MRI. MR images were reviewed for evaluation of the signal intensity and enhancement patterns of tumors and for correlation with the histopathologic findings., Results: The presence of very high signal intensity on T2-weighted images was a common feature of pure and mixed mucinous tumors. Fourteen pure tumors and one mixed tumor had very high signal intensity, and three pure and two mixed tumors had very high signal intensity and isointensity on T2-weighted images. The enhancement pattern during the early phase varied with the cellularity of pure tumors and with the distribution of nonmucinous components in mixed tumors. Hypocellular pure mucinous tumors had a typical pattern of gradual enhancement., Conclusion: Hypercellular pure mucinous tumors exhibit strong early enhancement and may be difficult to differentiate from mixed mucinous tumors. The distinction between the pure and mixed forms of mucinous carcinoma is important because mixed mucinous carcinoma more frequently undergoes lymph node metastasis and has a poorer prognosis than does pure mucinous carcinoma.

The open field activity of first generation (F1) hybrid male C57BL/6 x C3H mice irradiated with gamma-rays on the 14th day of gestation was studied at the following ages: 6-7 months, 12-13 months and 19-20 months. Doses were 0.1 Gy or 0.2 Gy. Open field activity was recorded with a camera. The camera output signal was recorded every sec through an A/D converter to a personal computer. The field was divided into 25 units of 8 cm square. All recordings were continuous for 60 min. The time which the 0.2-Gy group recorded at 6-7 months, spent in the 4 squares in the corner fields was high in comparison with the control group at the same age. The walking distance of the 0.1-Gy group recorded at 12-13 months was longer than that for the age matched control group. No effect of radiation was found on any of the behaviors observed and recorded at 19-20 months. The results demonstrate that exposure to low levels of gamma-rays on the 14th day of gestation results in behavioral changes, which occur at 6-7 and 12-13 months but not 19-20 months.

The open-field activity of first-generation (F1) hybrid male C57BL/6 x C3H mice irradiated with gamma rays on day 14 of gestation was studied at the following ages: 6-7 months (young), 12-13 months (adult) and 19-20 months (old). Doses were 0.5 Gy or 1.0 Gy. Open-field activity was recorded with a camera. The camera output signal was recorded every second through an A/D converter to a personal computer. The field was divided into 25 8-cm2 units. All recordings were continuous for 60 min. The walking speed of the 1.0-Gy group recorded at 19-20 months was higher than that for the comparably aged control group. The time which the irradiated group, recorded at 19-20 months, spent in the corner fields was high in comparison with the control group at the same age. Conversely, the time spent by the irradiated group in the middle fields when recorded at 19-20 months was shorter than in the comparably aged control group. No effect of radiation was shown for any of the behaviors observed and recorded at 6-7 and 12-13 months. The results demonstrate that such exposure to gamma rays on day 14 of gestation results in behavioral changes which occur at 19-20 months but not at 6-7 or 12-13 months.

The spontaneous circadian motor activity of first generation (F1) hybrid male C57BL/6xC3H mice irradiated with gamma rays on the 14th day of gestation was studied at the following ages: young (6-7 months), adult (12-13 months), and old (19-20 months). Doses were 0.1, 0.2, 0.5 or 1.0 Gy. A 12-hour day-night cycle was maintained with light on a at 6:00 hr. Spontaneous circadian motor activity was recorded with a capacitance-induction motility monitor for 48 consecutive hours. Activity was measured at 2-hour intervals, and the data stored on computer discs. The activity of the 1.0 Gy group recorded at 22:00 and 2:00 hr for young mice and at 2:00 hr for adult ones was significantly higher than that of the age-matched control group. Results suggest that male mice irradiated with 1.0 Gy at gestational day 14 show nocturnal hyperactivity in the young and adult stages.

Aggressive behavior (AB) in first generation (F1) hybrid male C57BL/6xC3H mice irradiated on the 14th day of gestation was studied at 100-135 days of age. Gravid female mice were irradiated with 1.0 or 2.0 Gy of gamma rays to the whole body. The AB of pairs of mice were recorded with a capacitance-induction motility monitor and on videotape. Recordings were continued for 90 min, starting at 2:00 PM. Vigorous wrestling, boxing and biting were regarded as AB. Data recorded at 15-min intervals were stored on micro-computer discs. The body weight for the irradiated group was significantly lower than that for the control group. The number of instances of AB was significantly higher in the irradiated group. The AB of the 2.0 Gy group was significantly more intensive than that of the control group. No difference in the duration of AB was found for the 2 irradiated and the control groups. Results demonstrate that male mice irradiated prenatally show increased aggressiveness.

Gross morphological changes of the brains of first generation (F1) C57BL/6 x C3H hybrid male mice irradiated prenatally were studied at 6 months of age. Gravid female mice were irradiated with 1.0 Gy, 2.0 Gy or 3.0 Gy of gamma radiation on the 14th day of gestation. The brain in dorsal view was photographed. The measurements of the area and the distance of parts of the brain were made from photographs, using a computer system for biological image analysis. The body and brain weight and the area and length of the cerebral hemispheres (CHs) showed dose-related decrease. There was a dose related increase in the area of the superior colliculi (SC), the distance (DP) from the point which the medial walls of the CHs begin to slope away from the midline to the posterior end of CHs, and the proportion of the DP to the CH length. From the results of the dose-response curve, it appears that the area of the SC and the proportion of DP to CH length are affected by small doses of less than 1.0 Gy.