Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions

Endoscopic submucosal dissection (ESD) has been widely used for resection of esophageal neoplastic lesions, but there are still technical challenges in treating large ones. Based on the development of tunneling technique, we report the first series in which the new technique of endoscopic submucosal tunnel dissection (ESTD) was used to remove large lesions in the esophagus. ESTD was attempted in five consecutive patients with esophageal lesions for which resection was indicated. In the operation, once the margin of the lesions had been marked, a submucosal tunnel was created by submucosal dissection from the oral incision to the anal incision. Bilateral resection was then performed to remove the lesion completely. The average length of the five lesions was 5.7 cm, and their extent as a proportion of the whole circumference of the lumen ranged from one third to four fifths. Operative time ranged from 50 minutes to 120 minutes (mean, 77 minutes). En bloc resection with negative lateral and basal margins was achieved in all lesions without complications.

The expression and role of oxidative stress markers in the serum and follicular fluid of patients with endometriosis

OBJECTIVE

To investigate the expression and role of oxidative stress markers in the serum and follicular fluid of patients with endometriosis.

MATERIALS AND METHODS

A prospective case-control study was conducted in 42 patients who underwent in vitro fertilization-embryo transfer (IVF-ET). They were divided into Group I: patients with endometriosis (n = 20) and Group II: patients with tubal factor infertility (n = 22). All patients underwent a long gonadotropin-releasing hormone (GnRH) agonist protocol for pituitary downregulation followed by controlled ovarian hyperstimulation. Level of reactive oxygen species (ROS), superoxide dismutase (SOD), and vitamin E (VE) were measured by enzyme-linked immunosorbent assay (ELISA). The results of IVF-ET between the two groups were compared.

RESULTS

The ROS levels in both serum and follicular fluid of the study group were significantly higher than in the control group. The serum levels of SOD and VE in the study group were significantly lower than those in the control group, but there was no difference in follicular fluid levels of SOD and VE between the two groups. Furthermore, the mature oocyte and fertilization rates in the study group were significantly lower than those of the control group. However, the levels of ROS, SOD, and VE in serum and follicular fluid were not significantly correlated with outcome following IVF-ET.

CONCLUSION

Patients with endometriosis have increased oxidative stress, as well as lower mature oocyte rates and fertilization rates. Nevertheless, there is no evidence that the oxidative stress status is directly related to the outcome of IVF treatment.

Associations between Vascular Endothelial Growth Factor Gene Polymorphisms and Susceptibility to Acute Mountain Sickness

Objective:

This study investigated associations between polymorphisms in the vascular endothelial growth factor (VEGF) gene and susceptibility to acute mountain sickness.

Methods:

Two hundred Han Chinese soldiers who developed acute mountain sickness after rapidly ascending to an altitude of < 3600 m and 200 control soldiers (who did not develop the condition) were enrolled in the study. Twelve single nucleotide polymorphisms (SNPs) of the VEGF gene were genotyped in all the study participants. Plasma VEGF concentrations were measured by enzyme-linked immunosorbent assay in 40 subjects with acute mountain sickness and 40 controls before and after exposure to high altitude.

Results:

The frequencies of the rs3025039 genotype and allele were significantly different between the groups. Two SNPs, rs3025039 (which involves a C→T allele variation at position 936 in the 3′ untranslated region) and rs3025030 (which involves a G→C allele variation in the intronic sequence), were associated with a decreased risk of acute mountain sickness.

Conclusion:

The SNPs rs3025039 and rs3025030 of the VEGF gene may be associated with a decreased risk of acute mountain sickness development.

Association of leptin receptor gene polymorphisms and essential hypertension in a Chinese population

BACKGROUND

The leptin receptor (LEPR) is an important regulator of leptin activity and resistance. Several single nucleotide polymorphisms (SNP) of LEPR have been linked to diseases accompanying obesity and/or obesity-related diseases in different populations. However, the results from published studies remain inconsistent rather than conclusive.

AIM

To investigate whether LEPR SNP are associated with essential hypertension and related metabolic traits in Chinese subjects.

MATERIALS AND METHODS

A total of 544 Chinese patients with hypertension and 357 non-hypertensive subjects were screened. The genotypes of LEPR polymorphisms were determined by PCR-restriction fragment length polymorphism methods. Demographic and biochemical characteristics including waist circumference, waist-to-hip ratio, body mass index (BMI), lipids profiles, glucose metabolism, and leptin levels were obtained for analysis.

RESULTS

This case-control study showed associations between the frequencies of AA genotype and A allele of Gln223Arg and hypertension (p=0.029, p=0.002, respectively). Furthermore, the Gln223Arg polymorphism was significantly associated with plasma leptin levels (p<0.001), while no correlations between Lys109Arg SNP and hypertension were found. Multivariate logistic regression analysis evidenced that A allele carriers of Gln223Arg (AA+AG) showed higher risks of hypertension than GG carriers after adjustment of age and sex (adjusted odds ratio: 1.549, 95% confidence interval: 1.031- 2.036, p=0.035). BMI, fasting serum insulin, oral glucose tolernace test (OGTT)-2h glucose, serum leptin, as well as LDL-cholesterol (LDL-C) levels were also independent risk factors of hypertension in this population. In addition, significant associations were observed between the Gln223Arg and Lys109Arg SNP and serum total cholesterol, LDL-C, and fasting plasma glucose levels in hypertensive patients. Besides, A allele of Gln223Arg had raised diastolic blood pressure, compared with GG carriers (p=0.001). While variance of Lys109Arg was associated with waist-to-hip ratio, OGTT-2h glucose, and homeostasis model assessment of insulin resistance (p<0.05).

CONCLUSIONS

LEPR polymorphisms may be a marker for susceptibility to essential hypertension in Chinese subjects, and be involved in the development of several features including dyslipidemia and impaired glucose regulation in hypertension subjects.

Genetic analysis of simultaneous geographic atrophy and choroidal neovascularization

AIM

To investigate clinical presentation and genotypes in patients with simultaneous geographic atrophy (GA) and choroidal neovascularization (CNV) and to compare with patients with GA or CNV only.

PATIENTS AND METHODS

Twenty patients with combined CNV-GA and 154 CNV only and 154 GA only were chosen based on clinical exam and imaging. Six single-nucleotide polymorphisms (SNPs)-rs2274700 and rs1061170 (complement factor H), rs10490924 and rs11200638 (HTRA1/LOC387715), rs2230199 (C3), rs9332739 (C2)-were genotyped using the SNaPshot method. Chi-squared tests were used for genetic analysis.

RESULTS

In patients with CNV-GA, GA progressed slowly and often preceded CNV. CNV presented as subretinal haemorrhage or fluid, with a sudden drop in visual acuity (VA). Comparing combined CNV-GA to GA and CNV only, patients with both had a higher frequency of at-risk alleles at both SNPs within the HTRA1 gene-rs10490924 (52.5%), rs11200638 (52.6%). Statistical significance was not achieved. CNV-GA patients had no protective alleles at SNP rs9332739 (C2), compared with GA (27%) and CNV only (10%).

CONCLUSION

There is a paucity of reports describing simultaneous CNV-GA. Clinical and genetic results may support the fact that GA and CNV fit on an age-related macular degeneration (AMD)-disease continuum and may clarify the disease processes in AMD.

Migrations and movements of adult Chinese sturgeon Acipenser sinensis in the Yangtze River, China

From 2006 to 2009, 27 ultrasonic-tagged wild adult Chinese sturgeon Acipenser sinensis [eight males, 19 females; total length (L(T)) range = 245-368 cm] were captured on the spawning ground just downstream of Gezhouba Dam (GZD) in the Yangtze River. Twenty-six individuals were tracked for 7 to 707 days (mean number of relocations = 859; range = 3-4549). Acipenser sinensis movements were divided into four categories: (1) spawning migration, two tagged A. sinensis (one female and one male) returned to the Yangtze River and migrated from the Yangtze Estuary (river kilometer, rkm, 0) to the spawning ground (1678 rkm) between June and October. Their mean upstream ground speed was 1.41 km h(-1) (range = 0.26-2.35 km h(-1) ). The speed of the male was faster than the female; (2) pre-spawning holding, four of five females tagged in November 2008 stayed within 1678.00-1674.15 rkm for c. 1 year before the spawning period; (3) spawning movements, all A. sinensis swam mostly from the tailrace of the GZD (1678 rkm) to the Miaozui (1674.15 rkm) reach and some moved downstream c. 18.21 rkm (range = 3.93-24.64 rkm), but then, returned upstream to the GZD. Most tagged A. sinensis were on the spawning ground on the day when the spawning occurred; (4) post-spawning migration males (n = 6) and females (n = 2) departed the spawning area on a different time schedule, females leaving before males. The mean seaward ground speed of six A. sinensis was 4.87 km h(-1) (range = 0.68-7.60 km h(-1) ). There were no significant differences (P > 0.05) in ground speeds among reaches or between sexes within reaches between telemetry receivers. These broad spatiotemporal scale results will help establish an effective protection strategy for the species in the Yangtze River.

Intravenous administration of adenoviruses targeting transforming growth factor beta signaling inhibits established bone metastases in 4T1 mouse mammary tumor model in an immunocompetent syngeneic host

We have examined the effect of adenoviruses expressing soluble transforming growth factor receptorII-Fc (sTGFβRIIFc) in a 4T1 mouse mammary tumor bone metastasis model using syngeneic BALB/c mice. Infection of 4T1 cells with a non-replicating adenovirus, Ad(E1-).sTβRFc, or with two oncolytic adenoviruses, Ad.sTβRFc and TAd.sTβRFc, expressing sTGFβRIIFc (the human TERT promoter drives viral replication in TAd.sTβRFc) produced sTGFβRIIFc protein. Oncolytic adenoviruses produced viral replication and induced cytotoxicity in 4T1 cells. 4T1 cells were resistant to the cytotoxic effects of TGFβ-1 (up to 10 ng ml(-1)). However, TGFβ-1 induced the phosphorylation of SMAD2 and SMAD3, which were inhibited by co-incubation with sTGFβRIIFc protein. TGFβ-1 also induced interleukin-11, a well-known osteolytic factor. Intracardiac injection of 4T1-luc2 cells produced bone metastases by day 4. Intravenous injection of Ad.sTβRFc (on days 5 and 7) followed by bioluminescence imaging (BLI) of mice on days 7, 11 and 14 in tumor-bearing mice indicated inhibition of bone metastasis progression (P<0.05). X-ray radiography of mice on day 14 showed a significant reduction of the lesion size by Ad.sTβRFc (P<0.01) and TAd.sTβRFc (P<0.05). Replication-deficient virus Ad(E1-).sTβRFc expressing sTGFβRIIFc showed some inhibition of bone metastasis, whereas Ad(E1-).Null was not effective in inhibiting bone metastases. Thus, systemic administration of Ad.sTβRFc and TAd.sTβRFc can inhibit bone metastasis in the 4T1 mouse mammary tumor model, and can be developed as potential anti-tumor agents for breast cancer.

Myotonia congenita with strabismus in a large family with a mutation in the SCN4A gene

BACKGROUND/AIMS

To determine the genetic basis of myotonia congenita (MC) and strabismus in a large Caucasian family.

METHODS

Seven patients making up four generations of a family with MC and strabismus were recruited. All patients had at least one standard ophthalmic examination, including best-corrected visual acuity, refraction, and ocular motility measurements. CLCN1 and SCN4A genes were sequenced and analysed for mutations.

RESULTS

Five out of the seven family members were diagnosed with MC by clinical history and electromyography. Ophthalmic history and exam revealed eyelid myotonia and strabismus. All patients with MC were diagnosed with strabismus between the ages of 3 and 6 and required surgical restoration of ocular alignment. Sequencing results revealed a c. 1333G>A; p. Val445Met mutation in the SCN4A gene.

CONCLUSION

There are few reports describing eyelid myotonia and strabismus in patients diagnosed with MC. We found significant ocular involvement in a family with a mutation in SCN4A. Future studies may confirm that MC with significant ocular involvement can be used to direct genetic analysis.

Improvement of glucose tolerance by rhein with restored early-phase insulin secretion in db/db mice

AIMS

In the present study, we investigated whether rhein exerted hypoglycemic action and rhein's effect on the pancreatic β cell in db/db mice.

MATERIALS AND METHODS

Thirty 4-week-old db/db mice were randomized to treatment with rhein (120 mg/kg) (no.=15) and placebo (1% natrium cellulose solution) (no.=15) for 8 weeks, respectively. Fifteen age-matched non-diabetic littermates db/m mice treated with placebo were studied as non-diabetic control. After an 8-week treatment, ip glucose tolerance test (IPGTT) and arginine tolerance test were performed. Area under curve (AUC) of insulin levels in IPGTT was calculated to evaluate insulin secretory function. Immunohistochemical staining of insulin was performed to estimate β cell mass. TUNEL assay was performed to determine β cell apoptosis. Islet isolation and perifusion were performed to evaluate kinetics of insulin release in vitro, especially first-phase insulin.

RESULTS

Compared with control group, AUC of glucose concentrations significantly decreased in the rhein-treated group (p<0.05). Simultaneously, AUC of insulin levels increased in the rhein-treated group (p<0.05), especially in the first 30 min after glucose load. Perifusion showed that the rhein-treated group manifested a significantly increase of first-phase insulin secretion. Immunohistochemical study and TUNEL assay showed that rhein treatment greatly preserved β cell mass and inhibited β cell apoptosis.

CONCLUSIONS

Rhein treatment significantly improved glucose- dependent and independent insulin secretion by preservation of β cell mass and inhibition of β cell apoptosis in db/db mice. The characteristics of rhein may make it a novel therapeutic means for preventing from or curing diabetes in the near future.

Continuous sorting of microparticles using dielectrophoresis

Sorting of particles such as cells is a critical process for many biomedical applications, and it is challenging to integrate it into an analytical microdevice. We report an effective and flexible dielectrophoresis (DEP)-based microfluidic device for continuous sorting of multiple particles in a microchannel. The particle sorter is composed of two components-a DEP focusing unit and a Movable DEP Trap (MDT). The trap is formed by an array of microelectrodes at the bottom of the channel and a transparent electrode plate placed at the top. The location of the trap is dependent on the configuration of voltages on the array and therefore is addressable. Flowing particles are first directed and focused into a single particle stream by the focusing unit. The streamed particles are then sorted into different fractions using the movable trap by rapidly switching the applied voltage. The performance of the sorter is demonstrated by successfully sorting microparticles in a continuous flow. The proposed DEP-based microfluidic sorter can be implemented in applications such as sample preparation and cell sorting for subsequent analytical processing, where sorting of particles is needed.

Improved glucose-stimulated insulin secretion by intra-islet inhibition of protein-tyrosine phosphatase 1B expression in rats fed a high-fat diet

BACKGROUND

Insulin resistance of pancreatic β-cell itself may be a potential link between systemic insulin resistance and impaired insulin secretion in Type 2 diabetes. Protein tyrosine phosphatase 1B (PTP1B) dephosphorylates tyrosine residues in insulin receptors (IR) and IR substrate (IRS) proteins, and thereby inhibits insulin signaling. Thus the impact of PTP1B expression on β-cell insulin pathway may affect insulin secretory function.

AIM

The aim of the present study was to investigate the effects of intra-islet inhibition of PTP1B expression on glucose-stimulated insulin secretion and potential mechanisms in rats fed a high-fat diet (HFD).

MATERIALS AND METHODS

Twenty 10-week-old Sprague Dawley rats were randomly assigned to a regular diet (RD) or a HFD for 8 weeks. At the end of the 8th week, fasting glucose, fasting insulin concentration and lipid profile were measured and an oral glucose tolerance test was done after 12-h fast. Then islet isolation was performed for static incubation and perifusion. Recombinant adenoviruses containing siPTP1B (Ad-siPTP1B), or siControl (Ad-siControl) sequences were constructed using AdEasy™ system. Islets were transfected and then assigned to the Ad-siPTP1B group, the Ad-siControl group, and mock control group. Real-time RT-PCR and Western blot were used to evaluate the expression level of PTP1B. Western blot of glucose transporter 2 (GLUT-2) and glucokinsase were also done to investigate the β-cell glucose-sensing apparatus. Islets were incubated with Krebs-Ringer bicarbonate containing 2.8 mmol/l glucose then 16.7 mmol/l glucose to evaluate glucose-stimulated insulin secretion (GSIS). Islet perifusion was also performed to evaluate kinetics of insulin release in vitro.

RESULTS

HFD rats manifested modest glucose intolerance compared with RD group. And PTP1B expression in isolated islets of rats in the HFD group was higher than that of the RD group. GSIS was impaired in islets of HFD rats (2.3±0.5-fold as basal for HFD vs 8.1±1.3-fold for RD; p<0.05). Ad-siPTP1B treatment resulted in 73% decrease in PTP1B mRNA levels and 61% decrease in PTP1B protein compared with islets treated with Ad-siControl (p<0.05). Simultaneously, PTP1B inhibition resulted in 4.7±0.8-fold increase of GSIS from basal (vs 1.9±0.1-fold for Ad-siControl, p<0.05). Perifusion showed notable improvement of first-phase insulin secretion by AdsiPTP1B treatment. Significant decrease of both GLUT-2 (by 49.8%) and glucokinase (GCK, by 43.7%) were found in the HFD group when compared with the RD group, while up-regulation of both GLUT-2 (by 98%) and GCK (by 62%) was achieved after PTP1B inhibiton by Ad-siPTP1B.

CONCLUSIONS

Intra-islet PTP1B is an important physiological regulator of glucose-induced insulin release and the characteristics of PTP1B inhibitors in insulin secretion could make it a potential novel therapeutics for protection of β-cell secretory function in Type 2 diabetes.

Renal risks of sodium phosphate tablets for colonoscopy preparation: a review of adverse drug reactions reported to the US Food and Drug Administration

AIM

Sodium-phosphate-containing colonoscopy preparations cause renal failure by the development of calcium phosphate nephropathy. Although Fleet's Phospho-Soda has been removed from the US market, sodium phosphate tablets sold as OsmoPrep and Visicol remain available. Our aim was to analyse renal risks of the sodium phosphate tablets.

METHOD

We conducted a retrospective study using the US Food and Drug Administration Adverse Event Reporting System, a voluntary reporting system available for public access. Renal adverse events were identified using search terms including renal impairment, increased blood urea nitrogen, increased creatinine, renal failure, acute renal failure, chronic renal failure, acute phosphate nephropathy, nephrocalcinosis, renal tubular necrosis, haemodialysis, nephropathy toxic, dialysis, peritoneal dialysis, renal injury, renal tubular disorder, decreased glomerular filtration rate and decreased creatinine clearance. Patient age, gender and body weight were compared with data for the general population in the National Health and Nutrition Examination Survey (NHANES).

RESULTS

In total 2,097,223 files were extracted from the US Food and Drug Administration website for 2004-2008 and the first 9 months of 2009. Of these, 178 patients on tablet preparations (71% women) were identified, with increasing numbers of renal adverse drug reactions reported from tablet preparations each year. The mean weight for women with renal complications from tablet preparations was 68.57 ± 1.78 kg, significantly lower than the national average weight of 74 ± 0.5 kg for the same age group (P = 0.003) in NHANES.

CONCLUSION

Renal adverse drug reactions from sodium phosphate tablets are more common in women with a mean body weight lower than the national average weight.

Effects of treadmill exercise on the expression of netrin-1 and its receptors in rat brain after cerebral ischemia

Recent evidence suggests that exercise improves functional outcome in animal models of cerebral ischemia. Since netrin-1 and its receptors, deleted in colorectal cancer (DCC) and uncoordinated gene 5B (Unc5B), act as important regulators in neural and vascular activities, we sought to determine whether netrin-1 and DCC and Unc5B are involved in the neuroprotective effects of exercise on rats with induced cerebral ischemia. A total of 108 rats were randomly distributed into three groups: sham-operated group (n = 12), middle cerebral artery occlusion (MCAO) group (n = 48), MCAO+treadmill exercise group (n = 48). Behavioral testing indicated that treadmill exercise could significantly improve neurologic deficits of rats with cerebral ischemia at day 14 and 28 after MCAO (n = 12, P<0.05 and P<0.01), but there was no significant difference at day 4 and 7. Quantitative reverse transcription polymerase chain reaction (qPCR) and Western blot analysis revealed that treadmill exercise enhanced netrin-1 and DCC expression, while it suppressed Unc5B expression in rat peri-ischemic brain area, especially at day 14 and 28 after MCAO (n = 4, P<0.05 or P<0.01). Immunofluorescence analysis showed that in the peri-ischemic area, netrin-1 was expressed in neuronal perikarya, DCC, however, was expressed in neural processes and peri-vascular astrocytes, while Unc5B was expressed mostly in neuronal perikarya and some processes. These results suggest that netrin-1 and its receptors DCC and Unc5B may engage in exercise-induced neural circuit remodeling in the peri-ischemic area, and exercise may promote survival of neurons in this area by regulating netrin-1-Unc5B signaling. Additionally, netrin-1 may also play a role in brain-blood barrier via DCC-immunoreactive peri-vascular astrocytes. In conclusion, we demonstrate that treadmill exercise has beneficial effects that may be attributed, at least in part, to the involvement of netrin-1 and its receptors DCC and Unc5B in the neuronal and vascular activities in brain-ischemic rats.

Elevated incidence of fractures in solid-organ transplant recipients on glucocorticoid-sparing immunosuppressive regimens

This study was conducted to assess the occurrence of fractures in solid-organ transplant recipients. Methods. Medical record review and surveys were performed. Patients received less than 6 months of glucocorticoids. Results. Of 351 transplant patients, 175 patients provided fracture information, with 48 (27.4%) having fractured since transplant (2-6 years). Transplants included 19 kidney/liver (50% male), 47 kidney/pancreas (53% male), 92 liver (65% male), and 17 pancreas transplants (41% male). Age at transplant was 50.8 ± 10.3 years. Fractures were equally seen across both genders and transplant types. Calcium supplementation (n = 94) and bisphosphonate therapy (n = 52) were observed, and an association with a lower risk of fractures was noted for bisphosphonate users (OR = 0.45 95% C.I. 0.24, 0.85). Fracture location included 8 (16.7%) foot, 12 (25.0%) vertebral, 3 (6.3%) hand, 2 (4.2%) humerus, 5 (10.4%) wrist, 10 (20.8%) fractures at other sites, and 7 (14.6%) multiple fractures. The estimated relative risk of fracture was nearly seventeen-times higher in male liver transplant recipients ages 45-64 years compared with the general male population, and comparable to fracture rates on conventional immunosuppressant regimens. Conclusion. We identify a high frequency of fractures in transplant recipients despite limited glucocorticoid use.

Abstract P1-01-02: Sentinel Node Biopsy Alone for Node Positive Breast Cancer, a Twelve Year Experience at a Single Institution

Background: The decision to perform complete node dissection for a tumor positive sentinel node is becoming more controversial. Five year data from the American College of Surgeon's Z011 trial recently demonstrated no difference in regional control in patients undergoing sentinel node biopsy alone for node positive disease. We report our institution's 12 year experience with sentinel node biopsy alone for tumor positive sentinel node and clinicopathologic factors that are associated with sentinel node biopsy alone.

Patients and Methods: From 1998 to 2009, a retrospective review was performed on 2,139 patients who underwent sentinel node biopsy alone for breast cancer. Of these 2,139 patients, 1,997 were tumor negative, 123 tumor positive and 19 cases were undocumented. Sentinel nodes were staged node positive according to AJCC criteria. Patient and tumor factors associated with sentinel node biopsy alone and locoregional recurrence, distant recurrence and overall survival were examined. Results: One hundred twenty three node positive patients underwent sentinel node biopsy alone with no completion axillary dissection for invasive breast cancer. Eighty two (66.7%) patient's sentinel nodes had macrometastases and 41 (33.3%) had micrometastases. Median follow-up was 8 years (range0.7 to 12yrs). Mean age was 57 years (range 32-92) and stage distribution was as follows: Stage IIA: 76 (62%) patients, Stage IIB: 40 (33%) patients, Stage III: 4 patients (3%), and Stage IV: 1 patient (0.8%). The mean size of the tumors was 1.9cm (range 0.1-9), 79 patients (64%) had grade I/II tumors and 36 (29%) had grade III tumors. Eighty nine (72%) underwent lumpectomy and 34 (28%) underwent mastectomy. When we examined patient and treatment factors that might explain omission of axillary dissection we saw that 95 (77%) patients had no comorbidities, 8 (6.5%) had one comorbidity and 20 (16%) had two or more comorbidities listed. Seventy seven patients (67%) received breast radiation in combination with adjuvant chemotherapy or hormonal therapy. Ninety (73%) patients had three or less sentinel nodes removed and 33 (27%) had four or more sentinel nodes removed. One hundred twenty patients had recurrence data, of which one (0.8%) had an axillary recurrence and 13 (11%) have expired. Of the 13 patients who died, four died of metastatic breast cancer and 9 of other causes. All patients with recurrence had macrometastasis to the lymph nodes. Conclusions: Favorable tumor and patient characteristics and high prevalence of adjuvant therapy may explain why completion axillary dissection was omitted in this group of tumor positive sentinel node patients. This study represents one of the longer follow-up periods in the literature and demonstrates that recurrent regional disease is rare with extended follow-up in patients undergoing sentinel node biopsy alone for node positive disease, even macrometastatic disease.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-02.

Abstract P6-03-04: Opening, Dynamic Prospective Cohort Research on the Small Focus Less than 1.1cm Shown by B Ultrasound in Breast

BACKGROUND: Ultrasound is the most frequent clinical way to examine breast in China. Because Chinese have small and high density breasts, mammography can not show some lesions, and it costs too much. There are 5%-10% patients detected small, nonpalpable lesions by ultrasound in clinic and physical examination. Most of the lesions are very small, without typical characteristics of malignant or benign tumor. So many positive results bother doctors and patients. OBJECTIVE To find an appropriate way to detect breast cancer early and reduce unnecessary biopsy. METHODS: A Opening, dynamic prospective cohort research on the small focus less than 1.1cm shown by B ultrasound has been performed from 1 st January 2009. 791 cases and 1064 lesions were selected to the study group. All patients are female, from 35 to 75 years old. The lesions are from 0.25 cm to 1.1cm in ultrasound and less than grade 3 in mammography according to BI-RADS. The patients are divided to 2 groups according to the mammography grade of BI-RADS. The first subgroup concludes 260 cases with grade 3, and the second subgroup concludes 531 cases with less than grade 2. The patients who were more than grade 4 in ultrasound according to BI-RADS accepted biopsy as soon as they got into group. Other patients accept ultrasound per 3 months and mammography per year. We will do biopsy when the lesions rise up to 130% of the original size, and when the lesion reduce to 70% of the original size in consecutive two times examination on ultrasound , the patient will leave the group. RESULTS: Total 70 cases were performed biopsy during 17months. 2 cases (0.7%) without family history of breast cancer were breast cancer during biopsy in the first subgroup.2 cases (0.3%) with family history of breast cancer were mastopathy with atypia during the procedure of follow up—biopsy in the second subgroup. CONCLUSIONS: Most small lesions which are negative on mammography are benign and need not be performed resection. Use of mammography can reduce unnecessary biopsy in Chinese. Ultrasound and family history of breast cancer should be considered well.

the cases of screening and biopsy