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Sankt Gallen, Switzerland

Kojima Y.,Breast Center | Tsunoda H.,St. Lukes International Hospital
Breast Cancer | Year: 2011

Background: Triple-negative breast cancer is characterized as a cancer with a high malignancy potential and a poor prognosis. Therefore, early detection of this subtype of breast cancer is vital. In this paper, we describe the mammography and ultrasound findings of triple-negative breast cancer in a large population and investigate the specific features of this subtype. Methods: From January 2007 to April 2010, mammography and ultrasound findings of 88 patients with triplenegative breast cancer were retrospectively reviewed. In this cohort, 52 patients underwent neoadjuvant chemotherapy. We compared the pathological chemotherapy effects and radiological findings among these patients. Mammograms were reviewed according to the Japanese mammography guideline. Ultrasound findings were classified as masses, low echoic area, distortions, and calcifications. Noted features included shapes, patterns of internal echoes, posterior echoes, vascularity, and elasticity scores. Results: On mammography, triple-negative breast cancers frequently presented with a mass (62.4%). Masses with microlobulated margins were the most frequent (39.6%), indistinct (32.0%) and circumscribed (20.8%) were commonly observed, but spiculated margins were rare (4.7%). On ultrasound, cancers were more likely to present as a mass (92.5%), and less likely to show attenuating posterior echoes (8.8%). Of the 40 cases obtained via elasticity imaging, 35 (87.5%) lesions were scored as 4 or 5. There were no significant differences in the mammography or ultrasound findings between the chemotherapy effects. Conclusion: Mammography and ultrasound imaging together revealed that the morphological features of triplenegative breast cancer include a lobulated mass, with less attenuating posterior echoes, some vascularity, and low elasticity. © The Japanese Breast Cancer Society 2010.


Joerger M.,Cantonal Hospital | Thurlimann B.,Breast Center
Expert Review of Anticancer Therapy | Year: 2013

The addition of adjuvant chemotherapy in early breast cancer improves overall survival by approximately 10%. Recommendations favor the use of anthracyclines and taxanes in patients with luminal B disease, while the use of an anthracycline, taxane and alkylating agent is recommended in triple-negative disease. In luminal B disease, the addition of chemotherapy to endocrine treatment depends on estrogen receptor expression and overall risk. Chemotherapy is not recommended in most patients with luminal A (highly hormone-sensitive and low proliferation) breast cancer. A major controversy is the addition of adjuvant chemotherapy to endocrine treatment in patients with estrogen receptor-positive breast cancer. In some of these patients, multigene signatures such as the 21-gene recurrence score may be a useful addition to histopathology. The introduction of molecular subtypes and gene signatures improves the complexity of early breast cancer treatment, and individual institutes have to find their policy based on their histopathological information and the availability of gene signatures. © 2013 Expert Reviews Ltd.


There has been dramatic progress in MRI technology during the past 20 years, and the rate of detection and diagnostic accuracy in regard to intraductal carcinoma and ductal carcinoma in situ (DCIS) have been increasing. First, we present MRI images of intraductal carcinomas and the terminology in the second edition of the BI-RADS-MRI to describe them. Next, we examined the data in our institution in regard to the following: (1) the DCIS detection rate, (2) the proportions of breast cancer and DCIS in MR-guided vacuum-assisted biopsies (VAB), (3) evaluation of the extent of intraductal carcinoma, and (4) diagnosis of extension of intraductal carcinoma into the nipple. MR images were acquired by performing a 1-min interval dynamic study with a 1.5-T MR scanner. The same radiologist evaluated the MRI in all of the cases. MR-guided VAB was performed by using a commercially available biopsy system. (1) The DCIS detection rate was 95% (148/156), and the DCIS lesions that MRI was unable to detect were low grade in 5 cases, intermediate grade in 2 cases, and high grade in 1 case. (2) The proportion of MR-guided VAB specimens that were breast cancer was 36% (71/200), and the proportion of breast cancers that were DCIS was 82% (58/71). (3) The proportion of margin-positive specimens in the 100 breasts in which breast-conserving surgery was performed was 11% (11/100), and the proportion in which MRI was the cause of the margin being positive was a mere 4% (4/100). (4) The positive predictive value of periductal enhancement and linear enhancement for a diagnosis of intraductal extension into the nipple was 83% (10/12) and 43% (3/7), respectively. Their negative predictive value was 100% (58/58). We concluded that MRI is a very useful examination for the diagnosis of intraductal carcinoma, and that it is important to become thoroughly familiar with the BI-RADS-MRI terminology and accurate interpretation methods. © 2011 The Japanese Breast Cancer Society.


Tozaki M.,Breast Center | Hoshi K.,Kameda Medical Center
American Journal of Roentgenology | Year: 2010

OBJECTIVE. The purpose of this article is to assess the histologic prognostic relevance of choline levels obtained using 1H MR spectroscopy with a 1.5-T MR unit in patients with invasive breast cancer and to compare the observed choline levels with the standardized uptake value obtained using FDG PET. MATERIALS AND METHODS. Single-voxel 1H MR spectroscopy and PET/CT were performed for 50 patients with invasive ductal carcinoma (1.5-3 cm in size). The normalized choline signal was calculated using an external standard method. RESULTS. Proton MR spectroscopy detected the presence of choline in 44 cases. The average normalized choline signal was 1.1 (range, 0-3.9). The average standardized uptake value was 6.5 (range, 1.1-23). The correlation (r) between the normalized choline signal and the standardized uptake value was 0.52 (p < 0.0001). The normalized choline signal was significantly correlated with nuclear grade (p = 0.0002), triple-negative breast cancer status (p = 0.0009), and estrogen receptor negativity (p = 0.007). The standardized uptake value was significantly correlated with nuclear grade (p = 0.0002), estrogen receptor negativity (p = 0.002), and triple-negative breast cancer status (p = 0.009). No significant differences were found between the progesterone receptor-positive and negative groups or between the human epidermal growth factor receptor 2-positive and negative groups. CONCLUSION. The choline levels obtained using 1H MR spectroscopy with a 1.5-T unit were well correlated with the standardized uptake value obtained using PET/CT and with the histologic prognostic parameters (nuclear grade, estrogen receptor status, and triple-negative lesion status). © American Roentgen Ray Society.


Tozaki M.,Breast Center
Magnetic Resonance in Medical Sciences | Year: 2011

Proton magnetic resonance (MR) spectroscopy (MRS) of the mammary gland region has customarily been used in basic research but is now commonly performed in clinical practice as MR techniques have improved. To debate its usefulness in a variety of fields and ultimately grade the timing of its use, a symposium entitled "Clinical Application and the Latest Technology of MRS-Timing of the Addition of MRS" was presented in 2009 at the 37th Annual Meeting of the Japanese Society for Magnetic Resonance in Medicine (JSMRM). MRS timing was classified into 3 grades according to when its addition: is always better, Grade 1; will sometimes be effective, Grade 2; and can provide only supplemental information, Grade 3. We describe the content of the meeting session on "Timing of the Addition of MRS in the Breast Cancer Field," explain the reasons for the timing classifications, and review previous papers.

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