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Hong SP, Lee SM, Yoo ID, Lee JE, Han SW, Kim SY, Lee JW. Clinical value of SUVpeak-to-tumor centroid distance on FDG PET/CT for predicting neoadjuvant chemotherapy response in patients with breast cancer. Cancer Imaging 2024; 24:136. [PMID: 39394156 PMCID: PMC11468257 DOI: 10.1186/s40644-024-00787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 10/08/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Since it has been found that the maximum metabolic activity of a cancer lesion shifts toward the lesion edge during cancer progression, normalized distances from the hot spot of radiotracer uptake to tumor centroid (NHOC) and tumor perimeter (NHOP) have been suggested as novel F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters that can reflect cancer aggressiveness. This study aimed to investigate whether NHOC and NHOP parameters could predict pathological response to neoadjuvant chemotherapy (NAC) and progression-free survival (PFS) in breast cancer patients. METHODS This study retrospectively enrolled 135 female patients with breast cancer who underwent pretreatment FDG PET/CT and received NAC and subsequent surgical resection. From PET/CT images, normalized distances of maximum SUV and peak SUV-to-tumor centroid (NHOCmax and NHOCpeak) and -to-tumor perimeter (NHOPmax and NHOPpeak) were measured, in addition to conventional PET/CT parameters. RESULTS Of 135 patients, 32 (23.7%) achieved pathological complete response (pCR), and 34 (25.2%) had events during follow-up. In the receiver operating characteristic (ROC) curve analysis, NHOCmax showed the highest area under the ROC curve value (0.710) for predicting pCR, followed by NHOCpeak (0.694). In the multivariate logistic regression analysis, NHOCmax, NHOCpeak, and NHOPmax were independent predictors for pCR (p < 0.05). In the multivariate survival analysis, NHOCpeak (p = 0.026) was an independent predictor for PFS along with metabolic tumor volume, with patients having higher NHOCpeak showing worse PFS. CONCLUSION NHOCpeak on pretreatment FDG PET/CT could be a potential imaging parameter for predicting NAC response and survival in patients with breast cancer.
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Affiliation(s)
- Sun-Pyo Hong
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea
| | - Ik Dong Yoo
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea
| | - Jong Eun Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Sun Wook Han
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea.
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Abstract
Breast-specific positron imaging systems provide higher sensitivity than whole-body PET for breast cancer detection. The clinical applications for breast-specific positron imaging are similar to breast MRI including preoperative local staging and neoadjuvant therapy response assessment. Breast-specific positron imaging may be an alternative for patients who cannot undergo breast MRI. Further research is needed in expanding the field-of-view for posterior breast lesions, increasing biopsy capability, and reducing radiation dose. Efforts are also necessary for developing appropriate use criteria, increasing availability, and advancing insurance coverage.
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Affiliation(s)
- Amy M Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Medical Physics, University of Wisconsin-Madison; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - Kanae K Miyake
- Department of Advanced Medical Imaging Research, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
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Kataoka M, Iima M, Miyake KK, Honda M. Multiparametric Approach to Breast Cancer With Emphasis on Magnetic Resonance Imaging in the Era of Personalized Breast Cancer Treatment. Invest Radiol 2024; 59:26-37. [PMID: 37994113 DOI: 10.1097/rli.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
ABSTRACT A multiparametric approach to breast cancer imaging offers the advantage of integrating the diverse contributions of various parameters. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the most important MRI sequence for breast imaging. The vascularity and permeability of lesions can be estimated through the use of semiquantitative and quantitative parameters. The increased use of ultrafast DCE-MRI has facilitated the introduction of novel kinetic parameters. In addition to DCE-MRI, diffusion-weighted imaging provides information associated with tumor cell density, with advanced diffusion-weighted imaging techniques such as intravoxel incoherent motion, diffusion kurtosis imaging, and time-dependent diffusion MRI opening up new horizons in microscale tissue evaluation. Furthermore, T2-weighted imaging plays a key role in measuring the degree of tumor aggressiveness, which may be related to the tumor microenvironment. Magnetic resonance imaging is, however, not the only imaging modality providing semiquantitative and quantitative parameters from breast tumors. Breast positron emission tomography demonstrates superior spatial resolution to whole-body positron emission tomography and allows comparable delineation of breast cancer to MRI, as well as providing metabolic information, which often precedes vascular and morphological changes occurring in response to treatment. The integration of these imaging-derived factors is accomplished through multiparametric imaging. In this article, we explore the relationship among the key imaging parameters, breast cancer diagnosis, and histological characteristics, providing a technical and theoretical background for these parameters. Furthermore, we review the recent studies on the application of multiparametric imaging to breast cancer and the significance of the key imaging parameters.
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Affiliation(s)
- Masako Kataoka
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan (M.K., M.I., M.H.); Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan (M.I.); Department of Advanced Imaging in Medical Magnetic Resonance, Graduate School of Medicine Kyoto University, Kyoto, Japan (K.K.M); and Department of Diagnostic Radiology, Kansai Electric Power Hospital, Osaka, Japan (M.H.)
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Imokawa T, Satoh Y, Fujioka T, Takahashi K, Mori M, Kubota K, Onishi H, Tateishi U. Deep learning model with collage images for the segmentation of dedicated breast positron emission tomography images. Breast Cancer 2023:10.1007/s12282-023-01492-z. [PMID: 37634221 DOI: 10.1007/s12282-023-01492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Dedicated breast positron emission tomography (dbPET) has high contrast and resolution optimized for detecting small breast cancers, leading to its noisy characteristics. This study evaluated the application of deep learning to the automatic segmentation of abnormal uptakes on dbPET to facilitate the assessment of lesions. To address data scarcity in model training, we used collage images composed of cropped abnormal uptakes and normal breasts for data augmentation. METHODS This retrospective study included 1598 examinations between April 2015 and August 2020. A U-Net-based model with an uptake shape classification head was trained using either the original or augmented dataset comprising collage images. The Dice score, which measures the pixel-wise agreement between a prediction and its ground truth, of the models was compared using the Wilcoxon signed-rank test. Moreover, the classification accuracies were evaluated. RESULTS After applying the exclusion criteria, 662 breasts were included; among these, 217 breasts had abnormal uptakes (mean age: 58 ± 14 years). Abnormal uptakes on the cranio-caudal and mediolateral maximum intensity projection images of 217 breasts were annotated and labeled as focus, mass, or non-mass. The inclusion of collage images into the original dataset yielded a Dice score of 0.884 and classification accuracy of 91.5%. Improvement in the Dice score was observed across all subgroups, and the score of images without breast cancer improved significantly from 0.750 to 0.834 (effect size: 0.76, P = 0.02). CONCLUSIONS Deep learning can be applied for the automatic segmentation of dbPET, and collage images can improve model performance.
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Affiliation(s)
- Tomoki Imokawa
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoko Satoh
- Yamanashi PET Imaging Clinic, Chuo City, Yamanashi Prefecture, Japan
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kanae Takahashi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama Prefecture, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
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Hatazawa J. The Clinical Value of Breast Specific Gamma Imaging and Positron Imaging: An Update. Semin Nucl Med 2022; 52:619-627. [PMID: 35346487 DOI: 10.1053/j.semnuclmed.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 01/15/2023]
Abstract
In the management of patients with breast cancer (BC), a mammography contributed to screen an early-stage patient, to plan a therapy strategy, to evaluate a therapy outcome, to detect a recurrence, and to reduce a mortality. Currently, various imaging modalities, such as CT, MR, Ultrasound (US), SPECT/CT, PET/CT, PET/MR have been utilized for the management of BC patients. In order to overcome a limited spatial resolution and sensitivity of whole-body systems in nuclear medicine imaging, dedicated breast imaging modalities were developed. One is a gamma imaging system with single/dual head scintillation detectors or semiconductor detectors associated with light compression device for breast parenchyma. Radiopharmaceutical for the gamma imaging is 99mTc-sestamibi. Another is a positron imaging system with opposite-type panel detectors and ring-shaped type detectors. Radiopharmaceutical for positron imaging is 18F-fluorodeoxyglucose. The breast-specific gamma and positron imaging systems were utilized mainly to detect small lesions less than 1 cm in diameter especially in patients with dense breast, to evaluate an effect of preoperative neo-adjuvant therapy, to plan surgical procedures (conservative-surgery vs mastectomy), and to detect a recurrence. By combining higher sensitivity and spatial resolution scanners with new radiopharmaceuticals, an information on molecular-level pathology of BC is increasingly available in an individual patient. This article reviewed clinical impact and future perspective of this field.
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Affiliation(s)
- Jun Hatazawa
- Department of Quantum Cancer Therapy, Research Center for Nuclear Physics, Osaka University, Osaka, Japan; Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan; Institute for Radiation Sciences, Osaka University, Osaka, Japan; Immunology Frontier Research Center, Osaka University, Osaka, Japan.
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Sasada S, Kai A, Kimura Y, Masumoto N, Kadoya T. Four Patterns of Abnormal Ring-Like Uptakes on Dedicated Breast PET. Clin Nucl Med 2022; 47:e192-e193. [PMID: 35006117 DOI: 10.1097/rlu.0000000000003877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The high resolution of dedicated breast PET (dbPET) enables the visualization of small breast cancers and a heterogeneity of breast tumors. Some tumors present with a ring-like appearance, the central uptake defect possibly reflecting intratumoral fibrosis and necrosis, associated with high-grade malignancy, and a triple-negative subtype. However, a ring-like finding is not only found in high-grade breast cancers. We describe 4 representative patterns of ring-like uptakes on dbPET: high-grade invasive cancer, intracystic tumor, extended noninvasive carcinoma, and change after vacuum-assisted breast biopsy. Ring-like uptakes on dbPET should be evaluated in association with clinical information.
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Affiliation(s)
- Shinsuke Sasada
- From the Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Satoh Y, Imokawa T, Fujioka T, Mori M, Yamaga E, Takahashi K, Takahashi K, Kawase T, Kubota K, Tateishi U, Onishi H. Deep learning for image classification in dedicated breast positron emission tomography (dbPET). Ann Nucl Med 2022; 36:401-410. [PMID: 35084712 DOI: 10.1007/s12149-022-01719-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to investigate and determine the best deep learning (DL) model to predict breast cancer (BC) with dedicated breast positron emission tomography (dbPET) images. METHODS Of the 1598 women who underwent dbPET examination between April 2015 and August 2020, a total of 618 breasts on 309 examinations for 284 women who were diagnosed with BC or non-BC were analyzed in this retrospective study. The Xception-based DL model was trained to predict BC or non-BC using dbPET images from 458 breasts of 109 BCs and 349 non-BCs, which consisted of mediallateral and craniocaudal maximum intensity projection images, respectively. It was tested using dbPET images from 160 breasts of 43 BC and 117 non-BC. Two expert radiologists and two radiology residents also interpreted them. Sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs) were calculated. RESULTS Our DL model had a sensitivity and specificity of 93% and 93%, respectively, while radiologists had a sensitivity and specificity of 77-89% and 79-100%, respectively. Diagnostic performance of our model (AUC = 0.937) tended to be superior to that of residents (AUC = 0.876 and 0.868, p = 0.073 and 0.073), although not significantly different. Moreover, no significant differences were found between the model and experts (AUC = 0.983 and 0.941, p = 0.095 and 0.907). CONCLUSIONS Our DL model could be applied to dbPET and achieve the same diagnostic ability as that of experts.
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Affiliation(s)
- Yoko Satoh
- Yamanashi PET Imaging Clinic, Chuo City, Yamanashi Prefecture, Japan
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Tomoki Imokawa
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan.
| | - Mio Mori
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Emi Yamaga
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Kanae Takahashi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Keiko Takahashi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Takahiro Kawase
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Saitama Prefecture, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Bunkyo Ku, Tokyo, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
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Miyake KK, Kataoka M, Ishimori T, Matsumoto Y, Torii M, Takada M, Satoh Y, Kubota K, Satake H, Yakami M, Isoda H, Ikeda DM, Toi M, Nakamoto Y. A Proposed Dedicated Breast PET Lexicon: Standardization of Description and Reporting of Radiotracer Uptake in the Breast. Diagnostics (Basel) 2021; 11:diagnostics11071267. [PMID: 34359350 PMCID: PMC8306936 DOI: 10.3390/diagnostics11071267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Dedicated breast positron emission tomography (dbPET) is a new diagnostic imaging modality recently used in clinical practice for the detection of breast cancer and the assessment of tumor biology. dbPET has higher spatial resolution than that of conventional whole body PET systems, allowing recognition of detailed morphological attributes of radiotracer accumulation within the breast. 18F-fluorodeoxyglucose (18F-FDG) accumulation in the breast may be due to benign or malignant entities, and recent studies suggest that morphology characterization of 18F-FDG uptake could aid in estimating the probability of malignancy. However, across the world, there are many descriptors of breast 18F-FDG uptake, limiting comparisons between studies. In this article, we propose a lexicon for breast radiotracer uptake to standardize description and reporting of image findings on dbPET, consisting of terms for image quality, radiotracer fibroglandular uptake, breast lesion uptake.
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Affiliation(s)
- Kanae K. Miyake
- Department of Advanced Medical Imaging Research, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan
- Correspondence: ; Tel.: +81-75-751-3760; Fax: +81-75-771-9709
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.K.); (T.I.); (Y.N.)
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.K.); (T.I.); (Y.N.)
| | - Yoshiaki Matsumoto
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (Y.M.); (M.T.); (M.T.)
- Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.Y.); (H.I.)
| | - Masae Torii
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama-City 640-8558, Wakayama, Japan;
| | - Masahiro Takada
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (Y.M.); (M.T.); (M.T.)
| | - Yoko Satoh
- Yamanashi PET Imaging Clinic, 3046-2 Shimokato, Chuo-City 409-3821, Yamanashi, Japan;
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-City 343-8555, Saitama, Japan;
| | - Hiroko Satake
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-City 466-8550, Aichi, Japan;
| | - Masahiro Yakami
- Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.Y.); (H.I.)
| | - Hiroyoshi Isoda
- Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.Y.); (H.I.)
| | - Debra M. Ikeda
- Department of Radiology, Stanford University School of Medicine, Breast Imaging, 875 Blake Wilbur Drive, Stanford, CA 94305-5826, USA;
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (Y.M.); (M.T.); (M.T.)
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.K.); (T.I.); (Y.N.)
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