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Yuko Tsunoda,1 Takashi Asahara,2 Koji Nomoto,3 Yukiko Yoshioka,4 Eisuke Fukuma1 1Department of Breast Surgery, Breast Center, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan; 2Department of Microbiological Research, Yakult Central Institute, Kunitachi, Tokyo 186-8650, Japan; 3Department of Molecular Microbiology, Tokyo University of Agriculture, Setagaya-ku, Tokyo 156-8502, Japan; 4Department of Breast Management Research, Oketani Breast Management Research Institute, Shinjuku-ku, Tokyo 162-0044, Japan 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. Keywords: infant feces, infectious breast milk, intestinal bacteria flora, Streptococcus species, fecal organic acids

Yuko Tsunoda,1 Akiko Sasaki,2 Naomi Sakamoto,1 Kou Teraoka,1 Rie Nakagawa,1 Yoshitomo Koshida,1 Eisuke Fukuma1 1Department of Breast Surgery, Breast Center, Kameda Medical Center, Chiba, Japan; 2Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan 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. Keywords: breast cancer, estrogen receptor, fatty acid synthase, microRNA

Purpose: The aim of this study was to perform the phantom experiment and demonstrate the clinical usefulness of tissue quantification using a linear array transducer and acoustic radiation force impulse (ARFI) technology.Materials and Methods: For the phantom study, the commercially available Elasticity QA Phantom Model 049 was used. First, we measured the shear wave velocity (m/s) for the four spheres and the background of the phantom. Then, the shear wave velocity at nine sites was measured, with the region of interest being moved gradually from a shallow region (3 mm) to a deeper region (38 mm). For the clinical study, the shear wave velocities of 15 solid breast mass lesions were measured.Results: The phantom study confirmed the feasibility of quantitative determination of the degree of tissue hardness. Dispersion of the measured values tended to be somewhat increased for the depths of 3 mm and 38 mm. The mean shear wave velocity was 2.07-2.93 m/s for five benign lesions, whereas higher shear wave velocities (n = 2) (7.15, 7.44 m/s) or "X.XX" (unmeasurable state) (n = 7) were found for malignant lesions other than mucinous carcinoma (2.44 m/s).Conclusion: ARFI tissue quantification is a potentially promising ultrasonographic technique for diagnosing breast lesions. [ABSTRACT FROM AUTHOR]

Background: Power Doppler ultrasonography (US) is used in addition to B-mode US as a tool for the differential diagnosis between benign and malignant lesions. However, there are few data showing how useful power Doppler US is for BI-RADS category assessment. Purpose: To assess how much power Doppler US contributed to increasing the category diagnosis from Breast Imaging Reporting and Data System (ACR BI-RADS(®)-US) category 3 to category 4. Material and Methods: A total of 2426 patients (age range 16-91 years, mean 52 years) who underwent B-mode and power Doppler breast US using a linear 10-MHz transducer were analyzed. We devised integrated US category classification (BI-RADS-Integral) based on BI-RADS descriptors and vascularity. Masses with a circumscribed margin, parallel orientation, and negative vascularity on power Doppler US were defined as category 3. Irregular-shaped masses with a spiculated margin or echogenic halo were defined as category 5. Masses with one of the four suspicious findings (no circumscribed margin, no parallel orientation, microcalcifications, and positive vascularity) were defined as category 4a, and masses with two or more suspicious findings were defined as category 4b. Results: There were 98 breast cancer cases, and the average sizes of invasive and non-invasive cancers were 15 mm and 18 mm, respectively. The frequency of breast cancer according to category was: 0.4% (3/714) of the category 3 cases, 2.7% (7/256) in category 4a, 64% (47/73) in category 4b, and 100% (41/41) in category 5. Among the cases with a category 4a mass lesion, there were 183 lesions whose category diagnosis had been raised from category 3 to category 4a based on the Doppler blood flow findings alone, and 3 (1.6%) of those lesions were breast cancer. All three of them were ductal carcinoma in situ (DCIS) cases. When the cut-off point was placed between category 3 and category 4, BI-RADS-Integral and BI-RADS-US without power Doppler had a sensitivity of 96.9% and 93.9%, respectively, specificity of 72.1% and 90.4%, respectively, and accuracy of 74.4% and 90.7%, respectively. Conclusion: The presence of Doppler blood flow increases the malignancy pick-up rate, but at the expense of a significant decrease in specificity and diagnostic accuracy and an increase in biopsy rate. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the clinical usefulness of acoustic radiation force impulse (ARFI) imaging for the differential diagnosis of breast lesions.Materials and Methods: We studied 40 solid mass lesions from a total of 40 patients (age range 29-67 years, mean 50 years). There were 18 benign lesions and 22 malignant tumors. ARFI imaging was performed using Virtual Touch tissue imaging. We examined the possibility of lesions seen on B-mode images being visually confirmed on ARFI images. When the lesion was visually confirmed, the lesions that were bright or dark inside were classified into patterns 1 and patterns 3, respectively. The lesions that failed to be visually confirmed were classified as pattern 2.Results: There were 3 pattern 1 lesions and 7 pattern 2 lesions; all of these lesions were benign. The remaining 8 benign lesions and 22 malignant lesions were determined to be pattern 3. The negative predictive value was 100%.Conclusion: ARFI imaging is a potentially promising ultrasonographic technique for the differential diagnosis of breast lesions, particularly complicated cysts without a cystic component on B-mode images. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to investigate the visualization rate for the mammary gland under the nipple with automated breast ultrasonography (US) and to compare the detectability of breast lesions under the nipple with automated breast imaging and handheld US imaging.Materials and Methods: A total of 60 patients underwent automated breast US (ABVS; Siemens Medical Solutions, Mountain View, CA, USA) and handheld US. The scans of the four segments of the breast included sequential scans in the upper-outer (C), lower-outer (D), lower-inner (B), and upper-inner (A) regions.Results: The visualization rates for the mammary gland under the nipple were 72% (86/120 breasts) in A-scanning, 84% (101/120) in B-scanning, 78% (93/120) in C-scanning, and 80% (96/120) in D-scanning. Interscanning mode differences were statistically significant only for A-scanning and B-scanning (P = 0.02). Eventually, 98% (117/120 breasts) of the breasts examined were rated as "visualized." In 14 of the 15 patients with breast lesions under the nipple, the lesions were detectable with handheld US and the ABVS. In the other patient, the lesion was not detectable on handheld US but was detected on ABVS imaging.Conclusion: ABVS imaging is by no means inferior to handheld US for detecting breast lesions under the nipple. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to clarify the frequency of malignancy and the histopathological characteristics of the lesions in patients undergoing magnetic resonance imaging (MRI)-guided vacuum-assisted biopsy (VAB).Materials and Methods: A retrospective review of 100 consecutive patients with 102 lesions who had undergone MRI-guided VAB was performed. The biopsies were performed on a 1.5-T MR scanner using a commercially available biopsy system. None of the lesions seen with MRI could be detected by mammography or second-look ultrasonography.Results: The average lesion sizes of the focus, mass, and nonmass lesions before the biopsy were 4.5, 8.2, and 21 mm, respectively. Twelve patients (12%) had lesions located in the deep portion of the breast, close to the pectoral muscle. The biopsy was successfully performed without important side effects in all patients. Histopathological findings were invasive ductal carcinoma in 6 (6%), in situ carcinoma in 28 (27%), and high-risk and benign in 68 (67%). Two high-risk lesions were upgraded to ductal carcinoma in situ (DCIS), and three DCIS lesions were upgraded to invasive ductal carcinoma at surgical excision.Conclusion: The high rate of DCIS might be a unique feature among Japanese women. However, MRI-guided VAB is necessary for MRI-only visible suspicious lesions in Japan. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the scanning technique for covering the whole breast using a commercially available automated breast ultrasonography (US) system.Materials and Methods: A total of 40 patients in the supine position underwent automated breast US (ABVS: Siemens Medical Solutions, Mountain View, CA, USA) and hand-held US. The scanning included sequential scans in the upper-outer, lower-outer, lower-inner, and upper-inner regions. After scanning all four segments of each breast using ABVS, hand-held US was performed in all the patients. The detectability of the lesions using the ABVS technique compared with that using the handheld US was evaluated. The average scanning time was compared between any two of the three examiners with various lengths of experience in breast US.Results: In all, 61 lesions were detected by hand-held US. The average size of the lesions was 7.7 mm (range 2.5-26.0 mm). The number of detected lesions by ABVS was consistent with those found by hand-held US in each patient. The average total scanning time for each examiner using ABVS was 10.9, 11.1, and 11.5 min, respectively. No significant difference was found in the total scanning time between any two of the three examiners.Conclusion: The four-scans technique for the major segments of the breast is thought to be an operator-independent, feasible method for performing automated breast US. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the efficacy of single-voxel (1)H magnetic resonance spectroscopy (MRS) at 1.5 T to evaluate early responses to neoadjuvant chemotherapy after the first treatment in breast cancer patients and to compare it to measurements of apparent diffusion coefficient (ADC) values derived from diffusion-weighted magnetic resonance imaging (MRI).Materials and Methods: Nine patients with breast cancer who were scheduled to receive neoadjuvant chemotherapy were recruited. MR examination after the first cycle was scheduled for a few days before the administration of the second dose.Results: Two patients were excluded from the study because their regimen was changed after the first cycle. MRS before chemotherapy demonstrated the presence of choline (Cho) at 3.22-3.23 ppm in six cases and at 3.27 ppm in one case. Diffusion-weighted MRI before chemotherapy demonstrated a localized high-signal lesion in all cases. The change of the integral value of Cho after the first cycle of chemotherapy showed a positive correlation with the change in lesion size (r = 0.91, P = 0.01), whereas no correlation was observed between the change of ADC values after the first cycle and the change in lesion size (r = 0.45, P = 0.32).Conclusion: MRS after the first cycle may be more sensitive to diffusion-weighted MRI to predict the pathological response. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the accuracy of measuring preoperative cancer extent using automated breast ultrasonography (US).Materials and Methods: This retrospective study consisted of 40 patients with histopathologically confirmed breast cancer. All of the patients underwent automated breast US (ABVS; Siemens Medical Solutions, Mountain View, CA, USA) on the day before the surgery. The sizes of the lesions on US were measured on coronal multiplanar reconstruction images using the ABVS workstation. Histopathological measurement of tumor size included not only the invasive foci but also any in situ component and was used as the gold standard. The discrepancy of the tumor extent between automated breast US and the histological examination was calculated.Results: Automated breast US enabled visualization of the breast carcinomas in all patients. The mean size of the lesions on US was 12 mm (range 4-62 mm). The histopathological diagnosis was ductal carcinoma in situ (DCIS) in seven patients and invasive ductal carcinoma in 33 patients (18 without an intraductal component, 15 with an intraductal component). Lesions ranged in diameter from 4 to 65 mm (mean 16 mm). The accuracy of determination of the tumor extent with a deviation in length of <2 cm was 98% (39/40).Conclusion: Automated breast US is thought to be useful for evaluating tumor extent preoperatively. [ABSTRACT FROM AUTHOR]

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., (© 2024. The Author(s), under exclusive licence to The Japanese Breast Cancer Society.)

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., (Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.)

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, η p 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, η p 2  =  = .074) and escape-avoidance marital communication (95% CI, -0.33 to -0.08; p = .001, η p 2  = .136). O!PEACE therapy significantly improved the partners' support (95% CI, 0.10-0.50; p = .001, η p 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., (© 2023 American Cancer Society.)

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., (Copyright © 2023. Published by Elsevier Inc.)

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.

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., Competing Interests: None to declare from any authors., (© the authors; licensee ecancermedicalscience.)

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., (© 2021. The Author(s).)

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.

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.

Background: To document 18 F-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.

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 mm 2 /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.

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.

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 (κ = 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., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

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.

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.

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., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

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.

Rationale and Objectives: We aimed to investigate the utility of problem-solving breast magnetic resonance imaging (MRI) for mammographic Breast Imaging Reporting and Data System (BI-RADS) categories 3 and 4 microcalcifications., Materials and Methods: Between January 1, 2010 and December 31, 2011, 138 women with 146 areas of categories 3 and 4 microcalcifications without sonographic correlates underwent breast MRI and had a stereotactic core biopsy using an 11-gauge needle or follow-up at least for 24 months. Positive predictive value (PPV), negative predictive value, sensitivity, and specificity were calculated on the basis of BI-RADS category, with categories 1-3 being considered benign and categories 4 and 5 being considered malignant., Results: Twenty-four cases (16.4%) were malignant (18 ductal carcinoma in situ, 6 invasive). MRI increased PPV and specificity from 43% to 68% and from 80% to 93% (P = .054 and .005) compared to mammography. Within 102 category 3 microcalcifications, 5 carcinomas were assessed correctly as category 4 by MRI. Within 44 category 4 microcalcifications, a correct diagnosis was made by MRI in 77% (34 of 44) as opposed to 43% (19 of 44) by mammography, and 80% (20 of 25) of unnecessary biopsies could have been avoided. Within the 24 carcinomas, 5 were negative at MRI. MRI-negative carcinomas have a significantly higher possibility of being low grade (ductal carcinoma in situ or invasive) (P = .0362)., Conclusions: Breast MRI has the potential to improve the diagnosis of category 3 or 4 microcalcifications and could alter indications for biopsy. Breast MRI could help predict the presence or absence of higher-grade carcinoma for category 3 or 4 microcalcifications., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the usefulness of the UltraClip ® dual trigger breast tissue marker (UltraClip) for sonographic localization, we investigate the sonographic visibility and sonographic appearance of the UltraClip placed in phantoms and patients., Materials and Methods: Ten UltraClips were placed in the target lesions in the phantoms. After the ultrasound examination of the UltraClip, the ultrasound images were compared to the real appearance of the UltraClip obtained by cutting the phantoms. In the patient, the UltraClip markers were placed after biopsy of a suspicious breast lesion or before or during neoadjuvant chemotherapy. The patients consented to return 1-3 weeks after the procedure for ultrasound imaging of the UltraClip., Results: The UltraClip placed in the phantom appeared as a hyperechoic structure with a mean maximum diameter of 5.5 mm, which was found to correspond to the metallic clip in 90% (9/10) of the cases, and as a hyperechoic tubular structure with a maximum diameter of 9.0 mm corresponded to the expanded polyvinyl alcohol polymer in the remaining 10% (1/10) of cases. On the other hand, the UltraClip was detected as a hyperechoic structure measuring 3.5 mm in size only in 9 of the 15 (60%) patients. The sonographic visibility of the UltraClip was not affected depending on whether the target lesion or post-biopsy scar was sonographically detectable or not [60% (6/10) vs. 60% (3/5)]., Conclusions: While sonographic localization by targeting the UltraClip may be useful in 60% of the patients, another localization technique will be needed in the remaining patients.

Background Because of its small size, a focus in breast magnetic resonance imaging (MRI) must be evaluated on the basis of characteristics other than morphologic features. Patient-related factors including patient age, in conjunction with lesion-related factors, could be useful for decision-making. Purpose To assess the probability of malignant foci based on both lesion- and patient-related factors, and to propose a relevant decision-making method. Material and Methods Foci in our breast MRI database dating from April 2006 to June 2013 were retrospectively identified and analyzed. A Fisher's exact test or a Mann-Whitney U test were performed for univariate analyses, and factors that showed a significant association with outcome in the univariate analyses were subjected to multivariate analysis using a logistic regression model. A decision tree was then drawn using the significant predictors confirmed by multivariate analysis. Results In total, 184 foci (168 benign, 16 malignant) in 184 patients were analyzed in our study. The presence of a washout pattern and older age were found to be significant predictors of malignancy ( P < 0.0001; odds ratio [OR], 17.8; P = 0.021; OR, 1.1, respectively). The main decisive node on the decision tree was the presence of a washout pattern, followed by whether the patient's age was >63 years. Conclusion An enhancing focus showing a washout pattern, especially in older patients, may warrant immediate biopsy rather than short-interval follow-up.

Background: Breast cancer screening using magnetic resonance imaging (MRI) has been introduced in Western countries primarily for populations with an elevated risk of breast cancer. We conducted an observer study involving an experimental abbreviated MRI interpretation by Japanese radiologists, using an enriched cohort, to evaluate its feasibility in a screening setting., Methods: Eighty-eight breast MRI examinations including 28 cases with breast cancer were enrolled as study subjects. Two radiologists independently reviewed the MR images, first with only two sequences (abbreviated series), and then with all of the images provided for clinical care (full diagnostic series). The difference in sensitivity and specificity was evaluated using McNemar's test. Interobserver agreement was assessed by calculating κ values., Results: A total of 176 breasts including 31 cancers (3 cases with bilateral disease) were included. No significant difference in sensitivity or specificity for either observer was observed between the abbreviated series and the full diagnostic series (observer 1: sensitivity 87.1 vs 87.1 %, p = 1.00, specificity 91.7 vs 90.3 %, p = 0.791; observer 2: sensitivity 93.5 vs 96.8 %, p = 1.00, specificity 83.4 vs 89.7 %, p = 0.064). Moderate interobserver agreement (κ = 0.56) was observed for the abbreviated series, whereas substantial agreement (κ = 0.69) was observed for the full diagnostic series., Conclusions: The diagnostic accuracy of the abbreviated breast MRI was not inferior to that of the conventional full diagnostic interpretation, although a slight decline in interobserver agreement was observed.

Purpose: Endoscopic nipple-sparing mastectomy (E-NSM) has been reportedly associated with smaller scars and greater patient satisfaction; however, long-term results of this procedure have not been made. The purpose of this retrospective study was to investigate the local recurrence (LR) rate and factors associated with it after E-NSM and to examine the oncologic safety of this procedure., Methods: We reviewed the medical records of a total of 421 breasts in 404 patients who underwent E-NSM to investigate the LR rate and the factors associated with it. The clinico-pathological features and the treatment and outcomes of the patients with LRs were also examined., Results: Eleven breasts (2.6 %) in 11 patients presented with LR as the first site of recurrence after a median follow-up time of 61 months. Among the 11 LRs, 9 patients presented with LR only, 1 patient exhibited regional lymph node recurrence, and 1 patient exhibited distant metastasis. The median time from surgery until LR was 25 months. Eight LRs developed near the original tumor site. The risk factors for LR in a multivariate analysis were a younger age of less than 40 years (p = 0.02), Stage III tumor (p = 0.01), and an inadequate surgical margin (p = 0.001). After the treatment, 6 patients had no evidence of disease, 2 patients died from metastatic disease, 2 patients experienced repeat LR, and the remaining patient who rejected excision exhibited a persistent LR., Conclusions: E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy.

Background: A new software version of VolparaDensity (Volpara Algorithm version 1.5.1) is capable of calculating volumetric breast density (VBD) using either full-field digital mammography (FFDM) or digital breast tomosynthesis (DBT) images. In this preliminary study, we evaluated the feasibility and consistency of this new automated software., Findings: Raw data from both DBT and FFDM were acquired from women breast cancer screening at our institution between April and August 2015 using. The DBT and FFDM images obtained under a single compression were collected and VBD was measured using fully automated software. A paired t test was used to analyze differences in the VBD calculated from paired FFDM and DBT images. The correlation coefficient (R value) was calculated and p < 0.05 was considered significant. Dualmodality images were acquired in 160 women; VBD data were available for all but one. There was a significant difference in the VBD of individual breasts calculated from DBT and FFDM and when data were compared per case (<0.001 and p = 0.006, respectively). There were very good to excellent correlations between data from FFDM and from DBT (R = 0.78, p < 0.0001; per breast, R = 0.89, p < 0.0001, per case, R = 0.91, p < 0.0001)., Conclusions: VBD from DBT was well correlated to that from FFDM, though significant differences were observed between the two.

Rationale and Objectives: This study aims to investigate the clinical significance of malignant non-mass enhancement (NME) descriptors in breast magnetic resonance images by assessing their correlation to the presence of invasion or lymph node metastasis., Materials and Methods: Three radiologists independently reviewed magnetic resonance images with malignant NMEs between January 2008 and December 2009. Distribution was assessed first, and then each of four internal enhancement patterns-clumped, clustered ring, branching, and hypointense area-was evaluated dichotomously (yes or no). Because clustered rings and hypointense areas were thought to be major structural elements of heterogeneous NMEs, they were also evaluated by integrating them into one collective descriptor we called the "heterogeneous structures." Chi-square test, Fisher exact test, or Student t test was used to analyze differences of variables by each reviewer. Positive predictive values (PPVs) of descriptors in predicting presence of invasion or lymph node metastasis were calculated. P < 0.05 was considered significant., Results: We included 131 malignant NMEs (76 in situ and 55 invasive) in 129 patients (two bilateral). All three observers' results showed clustered rings (PPVs 54.5%, 54.5%, 50.0%) (P = 0.0005, 0.038, 0.029) and hypointense areas (PPVs 63.6%, 61.5%, 73.9%) (P = 0.004, 0.024, 0.0006) to be significantly associated with invasion. When clustered rings and hypointense areas were integrated into heterogeneous structures, they were significantly associated with invasion (PPVs 54.3%, 53.3%, 51.8%) (P = 0.0003, 0.016, 0.003)., Conclusions: The NME descriptors clustered rings, hypoechoic areas, and heterogeneous structures, assessed collectively, were associated with invasive breast cancer., (Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Endoscopic breast surgery (EBS) for breast disease has been developed in Japan since 1995. The purpose of EBS is to accomplish the same local control as with conventional breast surgery through small skin incisions. Over the nearly 20-year history of EBS, equipment size has been reduced and procedures have been simplified. Recently, oncoplastic breast surgery, breast surgery using the open-window method, and imageguided nonsurgical ablation have been introduced into clinical practice for local breast treatment. Simplified procedures for EBS should be applied with newly introduced local treatments to achieve local control and expand the indications for those local treatments.

Endoscopic oncoplastic breast surgery represents a minimal invasive approach with the aim of both removing cancer safely and also restoring the breast image. It has less noticeable scar, excellent cosmetic outcomes, high patient satisfaction rate and recently reported relatively long term safety. Operative techniques for both endoscopic breast conserving surgery and endoscopic nipple/areola/skin sparing mastectomy have been described in detail. Two different working planes in which one of them is subcutaneous and the other one is sub-mammary planes are being used during the surgery. Surgical techniqe needs some instruments such as endoscopic retractor, light guided specific mammary retractor, wound protector and bipolar scissor. Endoscopic breast retractors provide magnified visualization and extensive posterior dissection facility. Tunneling method and hydrodissection simplify the technique in the subcutaneous field. Oncoplastic reconstruction techniques are also applied after the tumor resection by endoscopic method. Complication rates of endoscopic breast surgery are similar to open breast surgery rates. Quite succesful local recurrence, distant metastasis and overall survival rates have been declared. However it looks reasonable to wait for the results with longer follow-up before having a judgement about oncologic efficiency and safety of the endoscopic breast cancer surgery., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Purpose: We compared the safety, invasiveness and cosmetic outcomes between endoscopic breast-conserving surgery (endoscopic group) and surgery under direct vision (direct vision group) for treating breast cancer., Methods: We compared 100 cases of endoscopic surgery with 150 cases of direct vision surgery. The safety was evaluated in terms of the blood loss, length of the operation and presence or absence of complications, whereas the degree of invasiveness was assessed using preoperative and postoperative leukocyte counts, neutrophil counts, interleukin (IL-6) levels and fever. The cosmetic outcome was assessed on the basis of a breast evaluation by the medical staff and the patient's subjective satisfaction., Results: In both groups, serious postoperative complications were absent. No significant differences were observed in the leukocyte counts, neutrophil counts, IL-6 level or fever between the groups. An evaluation of the cosmetic outcomes by the staff showed a more favorable breast size, breast shape and scar condition in the endoscopic group. A significantly higher level of patient satisfaction was also observed in the endoscopic group. Postoperative local recurrence was absent., Conclusions: The endoscopic approach showed comparable safety and invasiveness, and provided better postoperative cosmetic outcomes than direct vision surgery. Our results suggest that endoscopic breast-conserving surgery is a potentially useful surgical method for the treatment of breast cancer.