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Cicciarelli F, Guiducci E, Galati F, Moffa G, Ricci P, Pediconi F, Rizzo V. Digital Mammography (DM) vs. Dynamic Contrast Enhancement-Magnetic Resonance Imaging (DCE-MRI) in Microcalcifications Assessment: A Radiological-Pathological Comparison. Diagnostics (Basel) 2024; 14:1063. [PMID: 38893590 PMCID: PMC11172046 DOI: 10.3390/diagnostics14111063] [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: 03/30/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast cancer and to identify the predictive value of DM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing microcalcifications for radiologic-pathologic correlation. We relied on our prospectively maintained database of suspicious microcalcifications on DM, from which data were retrospectively collected between January 2020 and April 2023. We enrolled 158 patients, all of whom were subjected to biopsy. Additionally, 63 patients underwent breast DCE-MRI. Microcalcifications with a linear branched morphology were correlated with malignancies (p < 0.001), among which an association was highlighted between triple negatives (TNs) and segmental distribution (p < 0.001). Amorphous calcifications were correlated with atypical ductal hyperplasia (ADH) (p = 0.013), coarse heterogeneous (p < 0.001), and fine-pleomorphic (p = 0.008) with atypical lobular hyperplasia (ALH) and fine pleomorphic (p = 0.009) with flat epithelial atypia (FEA). Regarding DCE-MRI, no statistical significance was observed between non-mass lesions and ductal carcinoma in situ (DCIS). Concerning mass lesions, three were identified as DCIS and five as invasive ductal carcinoma (IDC). In conclusion, microcalcifications assessed in DM exhibit promising predictive characteristics concerning breast lesion subtypes, leading to a reduction in diagnostic times and further examination costs, thereby enhancing the clinical management of patients.
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Affiliation(s)
- Federica Cicciarelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Elisa Guiducci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
- Unit of Emergency Radiology, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Veronica Rizzo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
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van Leeuwen MM, Doyle S, van den Belt-Dusebout AW, van der Mierden S, Loo CE, Mann RM, Teuwen J, Wesseling J. Clinicopathological and prognostic value of calcification morphology descriptors in ductal carcinoma in situ of the breast: a systematic review and meta-analysis. Insights Imaging 2023; 14:213. [PMID: 38051355 DOI: 10.1186/s13244-023-01529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Calcifications on mammography can be indicative of breast cancer, but the prognostic value of their appearance remains unclear. This systematic review and meta-analysis aimed to evaluate the association between mammographic calcification morphology descriptors (CMDs) and clinicopathological factors. METHODS A comprehensive literature search in Medline via Ovid, Embase.com, and Web of Science was conducted for articles published between 2000 and January 2022 that assessed the relationship between CMDs and clinicopathological factors, excluding case reports and review articles. The risk of bias and overall quality of evidence were evaluated using the QUIPS tool and GRADE. A random-effects model was used to synthesize the extracted data. This systematic review is reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS Among the 4715 articles reviewed, 29 met the inclusion criteria, reporting on 17 different clinicopathological factors in relation to CMDs. Heterogeneity between studies was present and the overall risk of bias was high, primarily due to small, inadequately described study populations. Meta-analysis demonstrated significant associations between fine linear calcifications and high-grade DCIS [pooled odds ratio (pOR), 4.92; 95% confidence interval (CI), 2.64-9.17], (comedo)necrosis (pOR, 3.46; 95% CI, 1.29-9.30), (micro)invasion (pOR, 1.53; 95% CI, 1.03-2.27), and a negative association with estrogen receptor positivity (pOR, 0.33; 95% CI, 0.12-0.89). CONCLUSIONS CMDs detected on mammography have prognostic value, but there is a high level of bias and variability between current studies. In order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary. CRITICAL RELEVANCE STATEMENT Mammographic calcification morphology descriptors (CMDs) have prognostic value, but in order for CMDs to achieve clinical utility, standardization in reporting of CMDs is necessary. SYSTEMATIC REVIEW REGISTRATION CRD42022341599 KEY POINTS: • Mammographic calcifications can be indicative of breast cancer. • The prognostic value of mammographic calcifications is still unclear. • Specific mammographic calcification morphologies are related to lesion aggressiveness. • Variability between studies necessitates standardization in calcification evaluation to achieve clinical utility.
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Affiliation(s)
- Merle M van Leeuwen
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | - Shannon Doyle
- Division of Radiation Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | | | - Stevie van der Mierden
- Scientific Information Services, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | - Claudette E Loo
- Department of Radiology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Medical Imaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Jonas Teuwen
- Division of Radiation Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Medical Imaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, the Netherlands.
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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Liu A, Ma Y, Yin L, Zhu Y, Lu H, Li H, Ye Z. Comparison of malignant calcification identification between breast cone-beam computed tomography and digital mammography. Acta Radiol 2023; 64:962-970. [PMID: 35815702 DOI: 10.1177/02841851221112562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Calcifications are important abnormal findings in breast imaging and help in the diagnosis of breast cancer. PURPOSE To compare breast cone-beam computed tomography (CBCT) with digital mammography (DM) in terms of the ability to identify malignant calcifications. MATERIAL AND METHODS In total, 115 paired examinations were performed utilizing breast CBCT and DM; 86 pathology-proven malignant lesions with calcifications detected on DM and 29 randomly selected breasts without calcifications were reviewed by three radiologists. The ability to detect calcifications was assessed on CBCT images. The characterization agreement of two imaging modalities was evaluated by the kappa coefficient. For breast CBCT images, the parameters for the display of calcifications were recorded. The Kruskal-Wallis test was used to compare the preferred slice thickness chosen by each of the three radiologists. The degree of calcification clarity was compared between two modalities using the Mann-Whitney U-test. RESULTS The combined sensitivity and specificity of three radiologists in 85 DM-detected calcifications detection on breast CBCT images were 98.43% (251/255) and 98.85% (86/87), respectively. CBCT images showed substantial agreement with mammograms in terms of the characterization of calcifications morphology (k = 0.703; P < 0.05) and distribution (k = 0.629; P < 0.05). CBCT images with a slice thickness of 0.273 mm and three-dimensional maximum-intensity projection (3D-MIP) were more beneficial for calcifications identification. No statistically significant difference was found between standard DM views and CBCT images for three radiologists on calcification display clarity. CONCLUSION CBCT images were comparable to mammograms in calcification identification and may be sufficient for malignant calcifications detection and characterization.
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Affiliation(s)
- Aidi Liu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Yue Ma
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Lu Yin
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Yueqiang Zhu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Hong Lu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Haijie Li
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Zhaoxiang Ye
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
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Chen L, Duan HY, Tang XM, Ma CC, Yang L, Xie ZY, Gao ZZ, Chen JF. A Mammography-Based Nomogram for Prediction of Malignancy in Breast Suspicious Calcification. Acad Radiol 2022; 29:1022-1028. [PMID: 34649781 DOI: 10.1016/j.acra.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
AIM To establish a predictive nomogram for malignancy risk stratification of micro-calcifications (MCCs) detected on mammography. MATERIALS AND METHODS Consecutive mammograms from January 2017 to March 2021 were retrospectively reviewed. Traditional clinical features were recorded and mammographic features were estimated according to the 5th BI-RADS. A nomogram was developed to graphically predict the malignancy risk based on multivariate logistic regression analysis. The discrimination and calibration performance of the prediction model was assessed. RESULTS There were 123 cases of suspicious MCCs with final pathological results identified with a malignancy rate of 55.2%. The malignancy rates of subgroups divided according to the morphology and distribution of MCCs, age, menopausal status and the maximum diameter of MCCs were significantly different. Multivariate logistic analysis showed that a menopause status of postmenopausal, maximum diameters of MCCs ≥2 cm, the morphology of MCCs as fine pleomorphic or fine linear or branching, and the distribution of MCCs as linear or segmental were predictive of a higher probability of malignancy. A prediction nomogram was developed based on four risk factors, including menopausal status as well as the maximum diameters, distribution and morphology of the MCCs. The AUC of that nomogram was 0.839 (95%CI:0.771-0.903). CONCLUSION In mammography, the morphology, distribution and maximum diameter of MCCs, and the menopausal status are independent predictors of malignant suspicious MCCs and are readily available in the clinical setting. The nomogram developed in this study for individualized malignancy risk stratification of suspicious MCCs shows a reliable discrimination performance.
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Affiliation(s)
- Lu Chen
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China
| | - Hui-Yu Duan
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China
| | - Xiao-Min Tang
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China
| | - Cheng-Cheng Ma
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China
| | - Li Yang
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China
| | - Zong-Yu Xie
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China
| | - Zhi-Zhen Gao
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China
| | - Jian-Fang Chen
- School of graduate (L.C., H.D.), Bengbu Medical College, Bengbu Anhui 233030, China; Department of Radiology (X.T., C.M., L.Y., Z.X., Z.G.), the First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China; School of Medical Imaging (J.C.), Bengbu Medical College, Bengbu Anhui 233030, China.
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Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. Radiology 2021; 302:246-255. [PMID: 34931856 PMCID: PMC8805655 DOI: 10.1148/radiol.211839] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ductal carcinoma in situ (DCIS) is a nonobligate precursor of invasive cancer, and its detection, diagnosis, and management are controversial. DCIS incidence grew with the expansion of screening mammography programs in the 1980s and 1990s, and DCIS is viewed as a major driver of overdiagnosis and overtreatment. For pathologists, the diagnosis and classification of DCIS is challenging due to undersampling and interobserver variability. Understanding the progression from normal breast tissue to DCIS and, ultimately, to invasive cancer is limited by a paucity of natural history data with multiple proposed evolutionary models of DCIS initiation and progression. Although radiologists are familiar with the classic presentation of DCIS as asymptomatic calcifications at mammography, the expanded pool of modalities, advanced imaging techniques, and image analytics have identified multiple potential biomarkers of histopathologic characteristics and prognosis. Finally, there is growing interest in the nonsurgical management of DCIS, including active surveillance, to reduce overtreatment and provide patients with more personalized management options. However, current biomarkers are not adept at enabling identification of occult invasive disease at biopsy or accurately predicting the risk of progression to invasive disease. Several active surveillance trials are ongoing and are expected to better identify women with low-risk DCIS who may avoid surgery.
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Affiliation(s)
- Lars J. Grimm
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Habib Rahbar
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Monica Abdelmalak
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Allison H. Hall
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
| | - Marc D. Ryser
- From the Departments of Radiology (L.J.G.), Pathology (M.A., A.H.H.), and Population Health Sciences (M.D.R.), Duke University, 2301 Erwin Rd, Box 3808, Durham, NC 27710; and Department of Radiology, University of Washington, Seattle, Wash (H.R.)
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Xiao H, Chen J, Duan L, Li S. Role of emerging vitamin K‑dependent proteins: Growth arrest‑specific protein 6, Gla‑rich protein and periostin (Review). Int J Mol Med 2021; 47:2. [PMID: 33448308 PMCID: PMC7834955 DOI: 10.3892/ijmm.2020.4835] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/21/2020] [Indexed: 01/27/2023] Open
Abstract
Vitamin K-dependent proteins (VKDPs) are a group of proteins that need vitamin K to conduct carboxylation. Thus far, scholars have identified a total of 17 VKDPs in the human body. In this review, we summarize three important emerging VKDPs: Growth arrest-specific protein 6 (Gas 6), Gla-rich protein (GRP) and periostin in terms of their functions in physiological and pathological conditions. As examples, carboxylated Gas 6 and GRP effectively protect blood vessels from calcification, Gas 6 protects from acute kidney injury and is involved in chronic kidney disease, GRP contributes to bone homeostasis and delays the progression of osteoarthritis, and periostin is involved in all phases of fracture healing and assists myocardial regeneration in the early stages of myocardial infarction. However, periostin participates in the progression of cardiac fibrosis, idiopathic pulmonary fibrosis and airway remodeling of asthma. In addition, we discuss the relationship between vitamin K, VKDPs and cancer, and particularly the carboxylation state of VKDPs in cancer.
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Affiliation(s)
- Huiyu Xiao
- Department of Physiology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Jiepeng Chen
- Sungen Bioscience Co., Ltd., Shantou, Guangdong 515071, P.R. China
| | - Lili Duan
- Sungen Bioscience Co., Ltd., Shantou, Guangdong 515071, P.R. China
| | - Shuzhuang Li
- Department of Physiology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
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