Abstract PD2-06: Preoperative diagnosis of sentinel lymph node metastasis using computed tomography lymphography for early breast cancer patients

Background: Sentinel lymph nodes (SLN) biopsy has been established as a standard of care in the treatment of early breast cancer. This technique represents a minimally invasive, highly accurate method of axillary staging and is an alternative to conventional axillary lymph node dissection. However, an indication of SLN navigation to metastatic disease may lead to misdiagnosis for staging. Recently, SLN identification using computed tomography lymphography (CTLG) has been reported in Japan. This study investigated the value of CTLG for preoperative prediction of SLN status in early breast cancer patients.

Patients and method: Between January 2013 and August 2016, 350 breast cancer patients without clinical evidence of lymph node metastasis were treated. On the day before the operation, CTLG was performed using 64-row multidetector helical CT scanner. Patients were placed in a supine position with their arms positioned in a cranial direction with CT guidelineattached to the skin at the axilla. We performed an intradermal injection in the periareolar area, using 4 ml of iopamidolwith 1 ml of local anesthetic. The contrasted lymph route and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. We established typical pattern of the lymphography: stain defect of SLN, stagnation of lymphatic route for preoperative diagnosis of metastatic SLN. SLN biopsy was performed using the fluorescence imaging system, Photpdynamic Eye (pde-neo, Hamamatsu Photonics Co., Japan) referring to the point by axillary compression technique by plastic device. Intraoperative pathological analysis of SLN was examined, and an axillary lymph node dissection was performed in patients with SLN metastasis pathologically.

Results: The median age of the 350 patients was 59 (range 28 – 90) years old. One patient was male and others were female. CTLG were safely performed in all patients. CTLG could visualize lymphatic route and accurately identify SLN in 336 (96.0 %) and 343 (98.0 %) cases, respectively. Lymphatic routes of CTLG were completely consistent with those of fluorescence imaging. The mean number of SLN identified by CTLG was 1.1. Fifty of 350 patients had metastatic SLN pathologically, and 11 of them had micrometastases of SLNs. The accuracy for metastatic diagnosis of SLN using CTLG without micrometastasis was 84.1 %, sensitivity was 82.1 % and specificity was 84.3 %. The positive predictive value was 40.5 % and negative predictive value was 97.3 %. There were no complications associated with SLN identification.

Conclusion: CTLG in SLN biopsy has some advantages in that this method is simple and quite useful for obtaining accurate anatomic images of the SLN, lymph vessels, and tumor. CTLG could select the candidate with truly node negative cases in early breast cancer patients, because it predicts lymph node metastasis preoperatively from natural status of the lymphographic image.

Citation Format: Abe H, Teramoto A, Tanaka M, Yamasaki K, Yoneda K. Preoperative diagnosis of sentinel lymph node metastasis using computed tomography lymphography for early breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-06.

A proposal of Fourier-Bessel expansion with optimized ensembles of bases to analyse two dimensional image

It is a critical issue to find the best set of fitting function bases in mode structural analysis of two dimensional images like plasma emission profiles. The paper proposes a method to optimize a set of the bases in the case of Fourier-Bessel function series, using their orthonormal property, for more efficient and precise analysis. The method is applied on a tomography image of plasma emission obtained with the Maximum-likelihood expectation maximization method in a linear cylindrical device. The result demonstrates the excellency of the method that realizes the smaller residual error and minimum Akaike information criterion using smaller number of fitting function bases.

Abstract P2-01-17: The combination of preoperative computed tomography lymphography and intraoperative fluorescence imaging navigation for sentinel lymph node biopsy of early breast cancer patients

Background: Sentinel lymph nodes (SLN) biopsy has been established as a standard of care in the treatment of early breast cancer. This technique represents a minimally invasive, highly accurate method of axillary staging and is an alternative to conventional axillary lymph node dissection. The combination of the radioisotope and dye-staining methods is the most accurate way to identify SLN. We had reported feasibility and safety of a new technique of SLN identification using fluorescence imaging of indocyanine green (ICG) injection without any need for training. Recently, SLN identification using computed tomography lymphography (CTLG) has been reported in Japan. This study investigated a usefulness of the combination of CTLG and fluorescence imaging for SLN biopsy of early breast cancer patients.

Patients and method: Between January 2013 and March 2016, 296 breast cancer patients without clinical evidence of lymph node metastasis were treated. On the day before the operation, CTLG was performed using 64-row multidetector CT. We performed an intradermal injection in the periareolar area, using 4 ml of contrast agent with 1 ml of local anesthetic. The contrasted lymph route and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. We established typical pattern of the lymphography: stain defect of SLN, stagnation of lymphatic route for preoperative diagnosis of metastatic SLN. During the operation, fluorescence images were obtained using the fluorescence imaging system, Photpdynamic Eye (pde-neo, Hamamatsu Photonics Co., Japan). After 0.5 ml dye mixed indigocarmin and ICG was injected intradermally into the periareolar skin, lymphatic route was observed with fluorescence images. SLN biopsy was performed referring to the point by axillary compression technique by plastic device. Intraoperative pathological analysis of SLN was examined.

Results: The median age of the 296 patients was 59 (range 28 – 90) years old. One patient was male and others were female. CTLG and fluorescence imaging were safely performed in all patients. CTLG could visualize lymphatic route and accurately identify SLN in 284 (95.9 %) and 290 (98.0 %) cases, respectively, whereas fluorescence imaging identified successfully lymphatic route and SLN in all patients. Lymphatic routes of CTLG were completely consistent with those of fluorescence imaging. The number of SLN identified by CTLG was significantly lower than that by fluorescence imaging (1.1 vs. 1.6, p<0.01). Thirty-nine of 296 patients had metastatic SLN pathologically, and 10 of them had micrometastases of SLNs. The accuracy for metastatic diagnosis of SLN using CTLG without micrometastasis was 83.9 %, sensitivity was 82.1 % and specificity was 84.1 %. The positive predictive value was 35.9 % and negative predictive value was 97.7 %.

Conclusion: The combination of CTLG and fluorescence imaging revealed easy and effective to detect SLN. The fluorescence imaging was more high detection rate and number of SLN than CTLG. Otherwise, preoperative diagnosis of SLN metastasis using CTLG would be useful to detect negative SLNs.

Citation Format: Abe H, Teramoto A, Yamasaki K, Yoneda K, Ogawa M, Kawasaki M, Kameyama M. The combination of preoperative computed tomography lymphography and intraoperative fluorescence imaging navigation for sentinel lymph node biopsy of early breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-17.

The spectrophotometrical analysis of rhododendrol-induced leucoderma using a novel multispectral camera

BACKGROUND

Many users in Japan of skin brightening/lightening cosmetics containing rhododendrol (RD) have developed leucoderma. Leucoderma appears on skin areas repeatedly treated with RD-containing cosmetics. RD-induced leucoderma (RDIL) presents different degrees of well-defined hypopigmentation. It is crucial to determine the degree of hypopigmentation to differentiate RDIL from vitiligo vulgaris (VV).

OBJECTIVES

To quantitatively evaluate hypopigmentation of RDIL lesions and the recovery of pigmentation, and to compare the hypopigmentation with VV and normal skin.

MATERIALS AND METHODS

Sixteen cases of RDIL, nine cases of VV and 15 healthy controls were examined using a novel multispectral camera (MSC) that can simultaneously obtain the reflection intensity at 10-nm wavelength intervals from 400 to 760 nm of the photographed area. ∆Absorbance was calculated by subtracting the log of reflection intensity of the target area from that of a white reflection standard.

RESULTS

Most RDIL lesions showed lower ∆Absorbance than healthy skin and higher ∆Absorbance than VV lesions between 400 and 550 nm. Statistical comparison of the maximum ∆Absorbance from 420 to 460 nm (Max∆Absorbance) for VV, RDIL and control skin showed that the Max∆Absorbance of RDIL was significantly higher than that of VV and lower than that of control skin. The comparison of ∆Absorbance of the same sites in RDIL lesions between the initial visit and 6 months later showed significant improvement after 6 months.

CONCLUSIONS

These studies demonstrated quantitative changes in RDIL and its recovery phase and suggested the utility of a MSC in obtaining objective colour information of skin disorders.

Effectiveness of A School-Based Universal Prevention Program for Enhancing Self-Confiden Considering The Extended Effects Associated With Achievement of The Direct Purposes of The Program

Introduction

We have developed a group of school-based universal prevention programs for children's health and adjustment. The programs are characterized by new theories such as the somatic-marker hypothesis and enjoyable methods that utilize animated stories and games. This study adopted one of the programs for the development of self-confidence.

Objective

The aim was to examine the effectiveness of the program. In addition to the direct purposes of the program, children's adjustments at school and homeroom class were evaluated as extended effects.

Methods

Participants were third grade children in six public elementary schools in Japan. The final sample included 442 children (219 boys and 223 girls). The program was implemented weekly in one regular 45-minute class over 8 weeks. Participants completed a battery of three questionnaires three times, 1 month before the start of the program (T1), 1 week before the start of the program (T2), and during 1 week after the last class of the program (T3).

Results

Results showed that all of the main endpoints of the program significantly improved in the intervention condition (i.e., changes from T2 to T3), compared to the control condition (i.e., changes from T1 to T2). Moreover, children's adjustment at school and homeroom class increased in the intervention condition, compared to the control condition. However, implicit affect was unchanged.

Conclusion

This study suggests that the program is effective for enhancing self-confidence, along with adjustments at school and in class. Future research that examines the sustainability of the effectiveness of the program is planned.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Effects of implicit affect on emotional coping and school adjustment: A short-term longitudinal study with a school-based universal prevention program for enhancing emotional abilities

In recent years, affect and emotions are hot research topics in the domains of psychology and brain science. Moreover, an increasing number of studies have started to investigate the effects of implicit affect on health and adjustment. The purpose of this study was to examine the effects of implicit affect on explicit emotional coping with others’ emotions and school adjustment in children.

Methods

Participants were 5th- and 6th-grade children in two public elementary schools in Japan. The final samples were fifty-six children (25 boys and 31 girls). Participants completed a battery of three questionnaires just before (T1) and after (T2) an school-based universal prevention program for enhancing emotional coping abilities with others’ emotions, which was implemented in eight classes during one month. The questionnaires were utilized for assessing implicit positive and negative affect (IPA and INA), explicit emotional coping abilities to identify, understand, and regulate others’ emotions, and the adaptive status of children at school.

Results

Hierarchical regression analyses showed that higher IPA at T1 was associated with higher explicit emotional coping and motivation for learning at T2. Also, higher INA at T1 was related to better peer relationship at T2. Moreover, higher IPA and INA at T1 were concerned with higher scores of classroom climate and approval at T2.

Conclusion

This study suggested that higher IPA leads to higher explicit emotional coping with others’ emotions. Also, it suggested that higher implicit affectivity (i.e., both higher IPA and INA) causes more adaptive status of children at school.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Abstract P3-01-02: A comparison of significance with indocyanine green fluorescence imaging method and computed tomography-lymphography in sentinel lymph node identification for early breast cancer patients

Background: Sentinel lymph nodes (SLN) biopsy has been established as a standard of care in the treatment of early breast cancer. This technique represents a minimally invasive, highly accurate method of axillary staging and is an alternative to conventional axillary lymph node dissection. The combination of the radioisotope and dye-staining methods is the most accurate way to identify sentinel lymph nodes. We had reported feasibility and safety of a new technique of SLN identification using fluorescence imaging of indocyanine green (ICG) injection without any need for training. Recently, SLN identification using computed tomography-lymphography (CTLG) has been reported in Japan. This study investigated the comparison of significance with fluorescence imaging method and CTLG.

Patients and method: Between January 2013 and May 2015, 213 breast cancer patients without clinical evidence of lymph node metastasis were treated. On the day before the operation, CTLG was performed using 64-row multidetector CT. We performed an intradermal injection in the periareolar area, using 4 ml of contrast agent with 1 ml of local anesthetic. The contrasted lymph flow and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. During the operation, fluorescence images were obtained using the fluorescence imaging system, Photpdynamic Eye (pde-neo, Hamamatsu Photonics Co., Japan). After 5 mg / 0.3ml ICG was injected intradermally in to the periareolar skin, lymphatic drainage was observed with fluorescence images. SLN biopsy was performed referring to the point by axillary compression technique by plastic device.

Results: The median age of the 213 patients was 59 (range 28 – 87) years old. CTLG and fluorescence imaging was safely performed in all patients. CTLG could visualize lymphatic flow and accurately identify SLN in 189 (89 %) and 196 (92 %) cases, respectively, whereas fluorescence imaging identified successfully lymphatic flow and SLN in all patients. Fluorescence imaging with axillary compression technique was visually easy to identify the location of SLN on the axillary skin even in obese patients. Lymphatic flows of CTLG were completely consistent with those of fluorescence imaging. The number of SLN identified by CTLG was significantly lower than that by fluorescence imaging (1.1 vs. 1.6, p<0.01). Twenty seven patients (13%) were found to have lymph node metastases pathologically, and 7 of them had micrometastases of lymph node. In case of partial enhancement of SLN with CTLG, the rate of positive metastasis was significant higher compared to the cases of whole enhancement (p<0.01), however, even if enhancement is poor, about 70 % cases without metastasis are present.

Conclusion: Both of fluorescence imaging and CTLG revealed easy and effective to detect SLN. The fluorescence imaging with fluorescence mapping showed strong fluorescence from all parts of the surgical field, which hindered identification of SLNs, and fluorescence imaging was more high detection rate of SLN.

Citation Format: Abe H, Yamasaki K, Teramoto A, Yoneda K, Ogawa M, Kawasaki M, Kameyama M. A comparison of significance with indocyanine green fluorescence imaging method and computed tomography-lymphography in sentinel lymph node identification for early breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-02.

A combination of ultrasound-guided rectus sheath and transversus abdominis plane blocks is superior to either block alone for pain control after gynecological transumbilical single incision laparoscopic surgery

PURPOSE

To investigate the efficacy of the combination of ultrasound-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks compared with TAP or RS block alone in gynecological single-incision laparoscopic surgery (SILS).

MATERIALS AND METHODS

Bilateral TAP blocks (Group A, n = 12), TAP and RS blocks (Group B, n = 12), and RS blocks (Group C, n = 12) with 40 ml ropivacaine/patient were performed for ovarian tumor SILS. The analgesic effects were evaluated using a numerical rating scale (NRS) at zero, six, 12, 24, and 48 hours post-surgery.

RESULTS

Umbilical pain on completion of general anesthesia was significantly less frequent in Group B (1/12) than Group A (7/12) (p = 0.03). The postoperative NRS scores were significantly lower in Group B than Group A at zero (p = 0.02) and six (p = 0.03) hours and Group C at zero (p = 0.001), six (p = 0.02), and 12 (p = 0.004) hours.

CONCLUSION

The combination of RS and TAP blocks reduced early postoperative pain compared with RS or TAP block alone for gynecological SILS.

Establishment of a new cell line susceptible to Cyprinid herpesvirus 3 (CyHV-3) and possible latency of CyHV-3 by temperature shift in the cells

A new cell line named CCF-K104 predominantly consisting of fibroblastic cells showed optimal growth at temperatures from 25 °C to 30 °C. Serial morphological changes in the cells induced by Cyprinid herpesvirus 3 (CyHV-3) included cytoplasmic vacuolar formation, cell rounding and detachment. Mature virions were purified from CyHV-3-infected CCF-K104 cells by sucrose gradient ultracentrifugation and had a typical herpesvirus structure on electron microscopy. Infectious CyHV-3 was produced stably in CCF-K104 cells over 30 viral passages. Our findings showed that CCF-K104 is a useful cell line for isolation and productive replication of CyHV-3. A temperature shift from 25 °C to 15 °C or 35 °C did not allow serial morphological changes as observed at 25 °C for 14 days. Under the same conditions, real-time PCR showed that CyHV-3 was present with low viral DNA loads, suggesting that CyHV-3 may establish latent infection in CCF-K104 cells. Amplification of the left and right terminal repeat sequences of the CyHV-3 genome arranged in a head-to-tail manner was detected by nested PCR following an upshift in temperature from 25 °C to 35 °C. The PCR results suggested that the circular genome may represent a latent form of CyHV-3.

Establishment of a model of acetaminophen-induced hepatotoxicity in different weekly-aged ICR mice

Acetaminophen (APAP), a widely used analgesic and antipyretic drug, has the potential to cause lethal hepatotoxicity. Mice are widely used for developing murine models of APAP-induced hepatotoxicity, and many researchers have used these models for APAP-related studies including the fields of biology, pharmacology and toxicology. Although drug-induced hepatotoxicity is dependent on a number of factors (species, gender and age), very few studies have investigated the effect of aging on APAP hepatotoxicity. In this study, we evaluated the effect of age on APAP-induced hepatotoxicity in different weekly-aged mice to establish a model of APAP-induced hepatotoxicity that is an accurate reflection of general experimental conditions. Male ICR mice 4, 6, 8, 10 and 12 weeks old were given APAP intraperitoneally, and mortality, hepatic damage and the plasma concentration of APAP metabolites were evaluated. It was found that younger male ICR mice were relatively resistant to hepatotoxicity induced by intraperitoneal APAP administration. In addition, the APAP-glucuronide concentration in plasma remained essentially the same among the differently-aged mice, while APAP-sulfate levels were dramatically decreased in an age-dependent manner. Thus, it is recommended that mice of the same ages be used in studies related to APAP-induced hepatotoxixity. These results provide evidence in support of not only the age-related changes in susceptibility to APAP-derived hepatotoxicity in mice but also in developing mouse models for APAP-related studies.