New diagnostic criteria in real-time elastography for the assessment of breast lesions

PURPOSE

Elastography is a new ultrasonographic method that has been examined as a diagnostic tool for breast lesions. This study was intended to create and define new elastographic criteria allowing assessment of whether breast lesions are malignant or benign.

MATERIALS AND METHODS

217 patients with a total of 245 breast lesions of unknown malignancy underwent ultrasound examination. The new eSie Touch Elasticity Imaging technology (Siemens, Erlangen, Germany) was used with a 10-MHz linear transducer (Acuson Antares). Lesions were examined using B-mode and real-time elastography (RTE). Each lesion was histologically assessed by core biopsy. Five RTE characteristics were examined: elasticity proportion (EP), different location on RTE in comparison with B-mode (MV), different contrast patterns (SOS), dorsal lesion limitation visibility and different size on RTE in comparison with B-mode.

RESULTS

54 malignant lesions (54 %) appeared inelastic, in contrast to the benign control group (34.5 %; P = 0.001). A completely elastic pattern was visible in 10 malignant (10 %) and 39 benign lesions (26.9 %). MV was identified in 23 cases, with 22 of the lesions being malignant and one benign. The SOS was negative in 89 malignant lesions (89 %) and positive in 100 benign lesions. The dorsal lesion limitation was visible on RTE without B-mode in 88 malignant lesions (88 %) and 27 benign lesions (18.6 %). The size was assessed as larger in 45 malignant lesions (45 %) and seven benign lesions (4.8 %).

CONCLUSION

SOS and a larger tumor size on RTE are specific characteristics of malignant breast lesions. EP, MV and distal mass border are further helpful signs to assess the malignancy of tumors.

Psychosomatic evaluation of patients awaiting lung transplantation

Levels of psychosocial functioning were assessed according to Transplantation Evaluation Rating Scale (TERS) in 113 patients prior to lung transplantation. The prevalence of mental disorders was 20%; in addition impaired mental status was observed in 12 (11%) patients. The most frequent diagnoses were dependence on tobacco (9%), adjustment disorders (4%), and dependence on alcohol (2%). In the clinical interview, 87 patients (77%) were assessed as eligible, 20 (18%) as risky, and 6 (5%) as high-risk candidates. The TERS total scores between the eligibility groups differed significantly (F = 19.5; df = 112; P < .001). There were no significant effects of gender and age. Significant inverse correlations were estimated between the TERS score and educational status (r = -.291; P = .002). TERS allows a standardized evaluation of lung transplant candidates with good discrimination into eligibility groups. General psychosocial adaptation is mainly based on the educational level, a factor that should be examined in psychosomatic assessments.

Dose Dependent Effects of G-CSF on Ca27.29 in Early Stage Breast Cancer Patients

Background:13% of 2556 patients (pts) examined in the SUCCESS trial showed elevated levels of Ca27.29 only after chemotherapy (SABCS2008). Early data indicate a possible relationship between the administration of G-CSF and a rise in the tumor marker. This analysis focuses on the dose dependency of this effect.Methods:The SUCCESS Trial is a phase III trial comparing FEC-Docetaxel vs. FEC-Doc-Gemcitabine regime and 2 vs. 5 years of treatment with zoledronate in patients with primary breast cancer in 3754 pts (BC) (N+ or high risk). Blood samples for this analysis are drawn before and after chemotherapy (CHT). Ca27.29 has been measured with ST AIA-PACK Ca27.29 reagent using MUC-1 for AIA-600II (Tosoh Bioscience, Tessenderlo, Belgium). The cutoff for Ca27.29 is &gt;=32 U/ml. For chi² analysis patients were grouped to increasing or not increasing values of Ca27.29 and 1 to 6 cycles with G-CSF or no G-CSF at all. The absolute difference of Ca27.29 values before and after CHT was correlated with the number of G-CSF cycles administered.Results:The analysis of Ca27.29 is based on the data of 2556 pts. 1252 pts (49%) received at least one course of G-CSF. 338 pts (13%) exceeded the threshold for CA27.29 only after CHT. In this group 209 pts (62%) received G-CSF and 129 (38%) did not. 1043 pts with stable or decreased CA27.29 received G-CSF (47%) and 1175 did not (53%). This difference was highly significant (p&lt;0.0001). Correlating the number of G-CSF cycles received during CHT with the absolute difference in Ca27.29 levels showed a highly significant positive correlation of 0.13 (Spearman-Rho; p&lt;0.0001[two-sided]).Discussion and Conclusion:This analysis gives strong evidence that there is a dose dependent correlation between elevated levels of CA27.29 post CHT and the application of G-CSF. This might be attributed to an illegitimate expression of MUC-1 in leucocytes during leucopoiesis. Whether this effect is also related to the destruction of remaining disseminated tumor cells needs to be further evaluated.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6030.

Evaluation of CA 27.29 as Prognostic Marker in Primary Breast Cancer Patients – Results of the German SUCCESS Trial

Background:While tumor markers are frequently used for the evaluation of treatment efficacy in metastatic breast cancer, the role of Muc-1 markers in primary disease and during recurrence-free follow-up is still under discussion. In the German multicenter SUCCESS trial we evaluated CA 27.29 in 3754 patients before and after adjuvant chemotherapy and 2 and 5 years after primary diagnosis.Methods:The SUCCESS Trial compares FEC-Docetaxel (Doc) vs. FEC-Doc-Gemcitabine (Doc-G) regime and two vs. five year treatment with Zoledronat in patients with primary breast cancer (N+ or high risk N-). CA27.29 has been measured with ST AIA-PACK CA27.29 reagent using MUC-1 for AIA-600II (Tosoh Bioscience, Tessenderlo, Belgium). The cutoff for positivity of CA27.29 is &gt;31 U/ml.Results:In 2807 primary breast cancer patients CA27.29 has been prospectively evaluated before and after chemotherapy. 22% of all patients had a marker &gt;31 U/ml (n=587, mean 19.00, range 3.04-410) before and 39% (n=1058, mean 23.34, range 2.70-330) after chemotherapy.After a median follow-up period of 18 months 138 patients developed a recurrence of their disease. 12% (n=17) of patients with recurrent disease had before chemotherapy a marker &gt;31 U/ml (mean 28.08, range 4.95-410). After completion of chemotherapy 16% of patients (n=22) had a CA 27.29 marker &gt;31 U/ml (mean 21.7, range 5.35-330).7% (n=10) had shown positivity of CA27.29 before and after therapy. 5% (n=07) of patients changed from positive to negative (cutoff for CA27.29) afterwards. 80% (n=109) were negative before and after therapy, whereas 8% (n=12) became positive after treatment.There is no significant difference in positivity of CA27.29 between Patients with an onset of disease recurrence in the first year (n=38), second year (n=68), the third year (n=24) after chemotherapy and all other prospectively evaluated patients with primary breast cancer (n=2784).Before chemotherapy treatment the prevalence of elevated CA27.29 in all 2807 primary breast cancer patients was equally distributed between the FEC-Doc and the FEC-Doc-G arm. After chemotherapy 34% in the FEC-Doc arm showed an increased level vs. 45% in the FEC-Doc-G arm. The correlation analysis showed no significant coherence between hormonal status (ER: p&lt;0.323; PR: p&lt;0.078), HER2/neu status (p&lt;0.308), Grading (p&lt;0.565) and CA27.29 level. Tumor size (p&lt;0.020) and the nodal status (p&lt;0.022) were significant associated with Ca27.29 levels.Conclusion:This marker will be useful for treatment monitoring; first of all because a close relation between Ca27.29 and tumor mass at primary diagnosis is evident. But only further results of the SUCCESS-trial, especially the evaluation of CA27.29 blood level at follow-up examination 2 years and 5 years after chemotherapy, will improve the prognostic relevance of this marker.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3023.