Abstract P6-02-11: The TILs-US scores based on ultrasonography can predict lymphocyte-predominant breast cancer before surgery

[Purpose]

Tumor-infiltrating lymphocytes (TILs) has been shown to be useful for predicting outcomes after surgery in breast cancer, and while TILs can be evaluated in preoperative biopsy tissue, heterogeneous distribution of TILs requires examination of all biopsied tissue samples.

We gave scores to preoperative ultrasonography (US) images with characteristics indicative of lymphocyte-predominant breast cancer (LPBC) and attempted to apply these for diagnostic prediction of LPBC. In this study, TILs-US scores based on preoperative US were assessed for their usefulness in predicting LPBC, the diagnosis of which was confirmed with postoperative pathology.

[Methods]

We evaluated 161 patients with invasive breast cancer between January 2014 and December 2017. All patients were treated by either mastectomy or breast-conserving surgery. Stromal lymphocytes were evaluated on preoperative biopsy tissues and surgical pathological specimens. Breast cancer samples with ≥ 50% stromal TILs were defined as pre-LPBC (preoperative biopsy tissues) and LPBC (surgical pathological specimens). TILs-US score was calculated from US before curative surgery. Based on clinicopathological factors including TILs-US scores based on preoperative US and pre-LPBC indicators, determinants useful for prediction of LPBC were examined.

[Results]

There were 39 cases of LPBCs and 122 cases of non-LPBCs in surgical pathological specimens. We set TILs-US score cut-offs for predicting LPBC at 4 points based on the receiver operating characteristics (ROC) curves (AUC, 0.88). There were significant predictors for LPBC in maltivariate logistic analysis (TILs-US score: OR26.8, p<0.001; pre- LPBC: 18.6, p=0.002; HER-2: OR9.2, p=0.009) in preoperative clinicopathological factor. The sensitivity, specificity and accuracy of TILs-US score for predicting LPBC were 0.74 (0.62-0.84), 0.89 (0.85-0.92) and 0.85 (0.79-0.90). Those of pre-LPBC were 0.51(0.42-0.55), 0.98 (0.96-1.00) and 0.87 (0.82-0.89), and those of HER2 were 0.28(0.19-0.36), 0.94(0.91-0.97) and 0.78 (0.74-0.82), respectively. The sensitivity of TILs-US score for predicting LPBC was significantly greater than those of pre- LPBC (p=0.04) and HER2 (p<0.001). On the other hand, the specificity of pre- LPBC for predicting LPBC was significantly greater than that of TILs-US score(p=0.002).

The sensitivity, specificity and accuracy of predicting LPBCPerformance measureTILs-US score (95%CI)Preoperative biopsyHER-2P, TILs-US score vs. Preoperative biopsyP, TILs-USscore vs. HER-2Sensitivity0.74 (0.62-0.84)0.51 (0.42-0.55)0.28 (0.19-0.36)0.04<0.001Specificity0.89 (0.85-0.92)0.98 (0.96-1.00)0.94 (0.91-0.97)0.0020.11Accuracy0.85 (0.79-0.90)0.87 (0.82-0.89)0.78 (0.74-0.82)0.230.11

[Conclusions]

TILs-US scores are an important factor that can predict LPBC preoperatively. The TILs-US score has particularly high sensitivity and may be an applicable index in the preoperative evaluation for LPBC.

Citation Format: Kanou A, Masumoto N, Shiroma N, Fukui K, Sasada S, Emi A, Kadoya T, Yokozaki M, Arihiro K, Okada M. The TILs-US scores based on ultrasonography can predict lymphocyte-predominant breast cancer before surgery [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-11.

Abstract P6-02-06: Characteristics of lymphocyte-predominant breast cancer in ultrasound images and their application to diagnostic prediction

[Purpose]

Tumor-infiltrating lymphocytes (TILs) is a prognostic factor for breast cancer, however, an accurate and simple evaluation method remains elusive. Therefore, we focused on findings characteristic of lymphocyte-predominant breast cancer (LPBC) in ultrasound (US) images. In this study, the application of preoperative US image assessment to diagnostic prediction of LPBC evaluated from postoperative pathological specimens, was appraised.

[Methods]

We evaluated 191 patients with invasive breast cancer between January 2014 and December 2017. All patients were treated by either mastectomy or breast-conserving surgery. Stromal lymphocytes were evaluated on surgical pathological specimens. Breast cancer samples with ≥ 50% stromal TILs were defined as LPBC. Preoperative US was performed in all cases and images were examined for characteristics indicative of TILs. Scores were given to US images with characteristic TILs and these TILs-US scores were assessed for their application to predict LPBC.

[Results]

There were 39 cases of LPBCs and 122 cases of non-LPBCs in surgical pathological specimens.

The characteristic US image findings predicting LPBC were shape (more lobulated), internal echo level (weaker) and posterior echoes (stronger). The TILs-US scores were given based on these three ultrasound tissue characterizations.We set TILs-US score cut-offs for predicting LPBC at 4 points (Sensitivity, 0.73; specificity, 0.87; accuracy, 0.83) based on the receiver operating characteristics (ROC) curves (AUC, 0.88). There were significant predictors for LPBC in maltivariate logistic analysis (Nuclear Grade (NG): OR3.4, p=0.02; ER: 5.7, p =0.007;HER-2: OR4.1, p=0.04; TILs-US score2: OR14.9, p<0.001) in preoperative clinicopathological factor. The sensitivity, specificity and accuracy of NG for predicting LPBC were 0.75, 0.69 and 0.71. Those of ER and HER2 were 0.33, 0.96 and 0.79.Sensitivity, specificity, and accuracy of NG, ER, and HER2 diagnoses were all lower than the TILs-US score, and the TILs-US score showed the best diagnostic ability.

The sensitivity, specificity and accuracy of predicting LPBCPerformance measureTILs-US score (95%CI)NGER or HER-2P, TILs-US score vs. NG,P, TILs-USscore vs. ER or HER-2Sensitivity0.73 (0.63-0.81)0.75 (0.64-0.84)0.327 (0.24-0.39)0.08<0.001specificity0.87 (0.83-0.90)0.69 (0.65-0.72)0.957 (0.93-0.98)<0.001<0.001accuracy0.83 (0.77-0.88)0.707 (0.65-0.376)0.785 (0.74-0.82)0.0040.25

Conclusions

LPBC has characteristic ultrasound tissue characterizations in US images. Thus, TILs-US scores based on US may be applicable to accurate and convenient preoperative diagnosis of LPBC.

Citation Format: Fukui K, Masumoto N, Shiroma N, Kanou A, Yokozaki M, Sasada S, Emi A, Kadoya T, Arihiro K, Okada M. Characteristics of lymphocyte-predominant breast cancer in ultrasound images and their application to diagnostic prediction [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-06.

[Detection of apolipoproteins E5 and E7 by a widely used commercial ApoE IFE kit--evidence provided by genotyping]

The purpose of this study is to examine a possibility to detect apolipoprotein (apo) E5 and E7 isoproteins with a commercial kit widely used (Phenotyping Apo E IFE System, Jokoh Co. LTD., Tokyo) and to clarify the frequency of the rare alleles in Central Japan. A total of 1,445 subjects living in Central Japan (1,030 hemodialysis patients and 415 apparently healthy individuals) was phenotyped for apo E isoproteins with the kit using isoelectric focusing with immunoblotting. In 23 subjects, unique apo E4 isoproteins, which migrate more basically than apo E4 isoprotein, were found. These unique isoproteins were proved to be apo E5 or E7 isoproteins by PCR with restriction fragment length polymorphism and with amplification refractory mutation systems, respectively. No significant differences in the frequencies of apo E5 or apo E7 alleles were observed between healthy individuals and hemodialysis patients (0.011 vs. 0.018, NS). The frequencies of apo E5 and E7 alleles were 0.001 and 0.005, respectively, in healthy individuals, and 0.003 and 0.005, respectively, in hemodialysis patients. These data in Central Japan were consistent with those in Western Japan (Matsunaga, et al, Clin Genet, 1995). These results indicate that the commercial kit is applicable to detect the rare alleles, apo E5 and E7 alleles and that the frequencies of the rare alleles in Central Japan are similar to those in Western Japan.

[Relapsing polychondritis: a case with respiratory failure]

A 48-year-old woman was admitted to our hospital with respiratory failure (Hugh-Jones IV-V). She was diagnosed as relapsing polychondritis 6 years ago. Her respiratory failure was due to pharyngial stenosis, deformity and inflammation of a trachea and lobar bronchus, and bronchial collapse. Her tracheobronchochondritis was managed by 500-700 mg/day of hydrocortisone and 50 mg/day of cyclophosphamide. Laboratory examination revealed only slight elevation of CRP and no elevation of anti-type II collagen antibody, although these parameters were very high on her first admission when she had severe polyarthritis, polychondritis of nose and auricles. Bronchoscopic findings were compatible with tracheobronchomalacia since pharyngial stenosis due to inflammatory pharyngitis and bronchial collapse due to tracheobronchochondritis were shown without lung parenchymal damage. We referred to the literature on tracheobronchomalacia which was associated by the varieties of respiratory and rheumatic diseases.

The effect of 17 beta-estradiol treatment on the mass and the turnover of bone in ovariectomized rats taking a mild dose of thyroxin

We performed the dosing experiment to establish whether estrogen administration has any beneficial effects on the mass and the turnover of bone in ovariectomized rats taking a mild dose of thyroxin. Thirty-five Wistar rats, 28 weeks of age, received ovariectomies (OVX) or sham operations and were divided into five groups. Group 1 was the sham group, Groups 2-5 were ovariectomized. Group 2 was the OVX-control, Group 3 treated with thyroxin 30 micrograms/kg/day (T4), Group 4, 17 beta-estradiol 0.3 mg/kg/week (E2), and Group 5, the combination of T4 and E2. The duration of the experiment was 12 weeks. At the end of the experiment, serum chemistries were measured. Bone minerals in the femur were determined with single photon absorptiometry and bone turnover was assessed histomorphometrically. Alkaline-phosphatase increased in Group 3 (OVX-T4), but it reduced in Groups 4 (OVX-E2) and 5 (OVX-T4 + E2). Bone minerals decreased in Groups 2 (OVX) and 3. In Group 4, it was preserved at the same level as in Group 1. Group 5 showed a significant increase of bone mass compared with Group 1. Eroded surface and osteoid surface increased in Groups 2 and 3 and they were reduced in Groups 4 and 5. Bone volume and mineral apposition rate were at a maximum in Group 5. This study demonstrated that 17 beta-estradiol was capable of preventing the bone mass decrease by regulating the turnover in ovariectomized rats taking a mild dose of thyroxin. Osteoblast function appeared to be stimulated in combination with 17 beta-estradiol and thyroxin.