Abstract P1-02-12: Evaluating the usefulness of dual-energy computed tomography for the preoperative diagnosis of the extent of spread of breast cancer

Background: The 2019 version 1 of the National Comprehensive Cancer Network guidelines states that magnetic resonance imaging (MRI)-based diagnosis of breast cancer “May be used for staging evaluation to define extent of cancer or presence of multifocal or multicentric cancer in the ipsilateral breast, or as screening of the contralateral breast cancer at time of initial diagnosis.” Therefore, we performed breast MRI to evaluate the extent of spread of breast cancer as part of the preoperative diagnosis.

Dual-energy computed tomography (DECT) is a new imaging technology that uses X-ray tube and detectors with two different tube voltages.

High-contrast and low-noise images, termed “virtual monochromatic image,” can be obtained using DECT. Recently, clinical cases using DECT have been reported in urology; however, only few cases have been reported on the diagnostic use of DECT for breast cancer.

Purpose: Evaluation of the usefulness of DECT in the preoperative diagnosis of extent of breast cancer spread.

Patients: Thirty-three patients with breast cancer, who underwent preoperative DECT and MRI, and were operated at our hospital from November 2016 to July 2018. The surgical specimens from the patients were excised horizontally. Patients who underwent preoperative chemotherapy were excluded from the study.

Methods: The maximum diameter, including that of the mass and non-mass enhancements in the horizontal sections of each lesion, was retrospectively measured by DECT and MRI. Moreover, the maximum diameter of the invading and intraductal lesions in the horizontal sections of the postoperative pathological sample were retrospectively measured.

In addition, the information on the patients’ background, clinical characteristics of the tumor, etc. were retrospectively collected and reviewed from the patients’ electronic medical records.

Results: The median age of the patients was 62 years. The median lesion size was 14.3 mm (0-75.8 mm) when measured with DECT, 13.1 mm (0-99.1 mm) with MRI, and 13 mm (3-95 mm) with postoperative pathology.

Spearman's rank correlation coefficient was 0.752 (p <0.0001) for pathology and MRI measurements, 0.855 (p <0.0001) for pathology and DECT measurements, and 0.892 (p <0.0001) for MRI and DECT measurements. The correlations between both the pathology and DECT measurements, and MRI and DECT measurements were significantly positive.

Subgroup analysis of factors, such as age and menopausal status, showed significant positive correlation in all subgroups.

Conclusion: As compared to MRI, DECT is advantageous in that it can simultaneously perform a whole-body metastasis search and scan in the supine position, more closer to the surgical position. Furthermore, in this study, DECT was able to evaluate the extent of spread of lesions, including the intraductal extension, almost similar to that of MRI, suggesting that the diagnostic performance may not differ across subgroups.

Additional analysis, such as evaluation of the size of infiltrated area alone, will be conducted and reported in future.

Citation Format: Haruna Yamasawa, Akari Murakami, Megumi Takaoka, Erina Kusakabe, Reina Aoki, Kana Taguchi, Kanako Nishiyama, Michiko Yamashita, Wakana Sugimori, Mie Kurata, Mana Fukushima, Riko Kitazawa, Kanako Okada, Megumi Matsuda, Yoshiaki Kamei, Yasutsugu Takada. Evaluating the usefulness of dual-energy computed tomography for the preoperative diagnosis of the extent of spread of breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-02-12.

Patient-related Risk Factors for Nausea and Vomiting with Standard Antiemetics in Patients with Breast Cancer Receiving Anthracycline-based Chemotherapy: A Retrospective Observational Study

PURPOSE

The aim of this study was to identify a high-risk or low-risk population for chemotherapy-induced nausea and vomiting among patients with breast cancer treated with a current standard 3-drug antiemetic regimen and receiving anthracycline.

METHODS

We analyzed data from chemotherapy-naive Japanese patients with breast cancer, who had received the first cycle of anthracycline-based regimen and were treated with a 3-drug combination of aprepitant, palonosetron, and dexamethasone. This study was carried out at Ehime University Hospital (Toon, Japan) using electronic medical records from May 2011 to June 2017. The primary end point was complete response (CR), which was defined as no emesis and no use of rescue medication.

FINDINGS

A total of 103 patients were included in this study. The percentages of patients who had a CR in the overall, acute, and delayed phases were 35.0%, 40.8%, and 50.5%, respectively. Multivariate logistic regression analysis revealed that age <55 years and body mass index <27.5 kg/m² were significantly associated with an increased risk for CR failure in the overall and acute phases. In contrast, a history of alcohol habit was significantly associated with a decreased risk for CR failure in overall phase.

IMPLICATIONS

The present findings suggest that, among patients with breast cancer receiving anthracycline and treated with aprepitant, palonosetron, and dexamethasone, patients younger than 55 years and having a body mass index <27.5 kg/m² are high-risk populations for chemotherapy-induced nausea and vomiting, whereas those with a history of habitual alcohol consumption is a low-risk one.

Olanzapine plus aprepitant, palonosetron, and dexamethasone for nausea and vomiting in patients with breast cancer receiving anthracycline: A retrospective study

This study aimed to compare the antiemetic efficacy and safety of a four-drug combination with those of a standard three-drug combination in Japanese patients with breast cancer treated with anthracycline. We retrospectively analyzed data from Japanese patients with breast cancer, who had received their first cycle of anthracycline and were treated with aprepitant, palonosetron, and dexamethasone with or without olanzapine. This retrospective observational study was performed at Ehime University Hospital using the electronic medical records. Multivariable and propensity score-adjusted analyses were performed to compare the onset of complete response (CR) failure between the groups. One-hundred and thirty patients were included in this study and the four- and three-drug group had 22 and 108 patients, respectively. Similar to multivariable logistic regression analysis, propensity-adjusted logistic regression analysis revealed that the four-drug group was markedly associated with a decreased odds of CR failure in the overall, acute, and delayed phases (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.10–0.73; OR: 0.28, 95% CI: 0.10–0.76; and OR: 0.15, 95% CI: 0.04–0.57, respectively). Additionally, treatment-related adverse events were well tolerated in both the groups. These findings suggest that the antiemetic efficacy of the four-drug combination is superior to that of the standard three-drug combination.

[A Treatment Strategy against Double Presentation of Breast Cancer and Malignant Lymphoma]

Case 1 involved a 75-year-old woman with breast cancer and diffuse large B-cell lymphoma(DLBCL).Although we initially administered the R-CHOP regimen, the breast tumor increased in size and surgery had to be performed.After surgery, the R-CHOP regimen was re-initiated and DLBCL achieved clinical complete response.Case 2 involved a 74-year-old woman with breast cancer and gastric MALT lymphoma.After administration of rituximab and H. pylori eradication, a therapeutic effect was achieved in the lymphoma.A docetaxel and FEC regimen was continuously administered and surgery was performed. Case 3 involved a 62-year-old woman with breast cancer and follicular lymphoma.She presented with a history of DLBCL treatment.We performed mastectomy and sentinel lymph node biopsy, which revealed metastasis of breast cancer, and axillary lymph node dissection was subsequently performed.Considering the pathological stage, adjuvant chemotherapy was needed.We selected the TCH regimen based on her past treatment.In conclusion, it is necessary to treat patients with double presentation of breast cancer and malignant lymphoma through cooperation with different departments.

[A Case of Microangiopathic Hemolytic Anemia with Bone Marrow Carcinomatosis from Breast Cancer]

We report a case of microangiopathic hemolytic anemia(MHA)caused by metastatic breast cancer treated with weekly paclitaxel. A 58-year-old woman was diagnosed with metastatic breast cancer 2 years earlier. She was treated with various chemotherapy regimens and hormonal therapy, before being switched to fulvestrant 3 months earlier. She presented with severe anemia, and was diagnosed with MHA with bone marrow carcinomatosis following bone marrow biopsy. She was treated with weekly paclitaxel and recovered successfully. A subsequent biopsy showed that the bone marrow carcinomatosis had decreased. MHA due to breast cancer is rare and is associated with poor prognosis; however, rapid initiation of chemotherapy may be effective.

[Cytokine production by peripheral blood mononuclear cells in bronchial asthma treated with suplatast tosilate]

Supratast tosilate is a newly developed 'anti-allergic' drug and it has been shown to suppress cytokine production by type-2 helper T cells (Th2) in vitro. However, it is unclear whether a similar inhibitory effect on Th2 cytokines production is produced iv vivo. To elucidate the actions of the in vivo mechanisms of this drug, we isolated peripheral blood mononuclear cells (PBMCs) from 10 atopic asthmatics treated with supratast tosilate and investigated the capacity for cytokine production ex vivo. Interleukin (IL)-5 production by PBMCs stimulated with the combination of phorbol myristate acetate and ionomycin were reduced significantly 6 or 12 weeks after the treatment with supratast tosilate. In contrast, no significant reduction was seen in IL-4 or Interferon (IFN)-gamma production. The peripheral blood eosinophil count and weeks, but no significant difference was sees in total IgE levels. Both morning and evening peak expiratory flow were significantly elevated after 6 weeks. These results suggest that supratast tosilate improves the disease status of bronchial asthma through its ability to inhibit the production Th2 cytokines, at least IL-5, in vivo.

Concurrence of sarcoidosis and lung cancer. A report of four cases

Although sarcoidosis and lung cancer are both frequently encountered conditions, their simultaneous occurrence in the same patient is unusual. In this report, we describe 4 cases of their concurrence and discuss the possible pathogenic mechanisms of their concurrent appearance. In particular, in 2 of the cases, both diseases had coexisted for a long period (more than 6 and 4 years, respectively), showing a surprisingly slow growth of cancers. Although the chest computed tomography showed hilar and mediastinal lymphadenopathy, the histopathological findings of the excised lymph nodes of both cases revealed no metastasis. The causal relationship between sarcoidosis and lung cancer remains uncertain, but cases such as these may be helpful in elucidating its precise nature.

Development of a new device for recording condylar head movement

Several excellent devices have recently been developed to precisely record mandibular movement. However, these devices are not always suitable for use under certain conditions, such as during sleep, because they incorporate a face bow unit. We report here a newly developed, easy and convenient recording device that does not require the use of an instrument within the mouth. Instead, a subminiature pressure transducer is inserted between the outer surface of a fixation device in the external auditory meatus and the anterior cutaneous surface of the external auditory meatus. The fixation device was made using silicone impression material in the shape of the inner external auditory meatus. Following moulding, the material was cut in half and the parts were reconnected using a coiled spring. This method is based on a routine clinical method for palpating the external auditory meatus to observe condylar head movement. By comparing the results obtained using this device with those obtained using CADIAX, we confirmed that it is useful for recording the movement of the condylar head in routine clinical examinations.

Cytokine-induced neutrophil chemoattractant in a rat model of lipopolysaccharide-induced acute lung injury

To elucidate the role of major chemotactic factors, cytokine-induced neutrophil chemoattractant (CINC), leukotriene B4 (LTB4) and C5a in lipopolysaccharide (LPS)-induced acute lung injury in rat, we employed three reagents: anti-CINC-1 antibody, an LTB4 receptor antagonist (ONO-4057) and an anti-complementary agent (K-76COONa). Rats were divided into five groups: (1)control group; (2) LPS group, which received intratracheal instillation of LPS (100 microg/kg); (3) Anti-CINC group, which received intratracheal coinstillation of LPS with anti-CINC-1 antibody (1 mg/kg); (4) LTB4-Ra group, which received intravenous ONO-4057 (10 mg/kg) prior to intratracheal LPS; (5) Anti-C5a group, which received intravenous K-76COONa (100 mg/kg) prior to intratracheal LPS. The number of neutrophils in bronchoalveolar lavage (BAL) fluids 6 h after LPS instillation was significantly reduced in the Anti-CINC group, however, no reduction was found in either the LTB4-Ra group or Anti-C5a group. The levels of CINC-1, CINC-2alpha and CINC-3 in BAL fluids were significantly higher in the LPS group than in the saline-instilled control group. In vitro, the production of CINC-1 and CINC-3 from LPS-stimulated macrophages was significantly elevated compared to unstimulated macrophages 6 h later. The increase in CINC-2alpha production was markedly less than that of CINC-1 or CINC-3. These results indicate that CINCs, especially CINC-1 and CINC-3 play an important role in the recruitment of neutrophils to the lung in LPS-induced acute lung injury.

[Electromyographic power spectral analysis of sternocleidomastoid muscle during sustained voluntary clenching]

The purpose of this study was to investigate the changes of the activity of the sternocleidomastoid (SCM) muscles during sustained voluntary clenching. Ten healthy male subjects without any occlusal functional problems were asked to clench as long as possible in the intercuspal position while keeping the electromyographic activity of the masseter muscle at the 50% maximum voluntary contraction. Frequency analysis was carried out by computer using a fast Fourier transform algorithm to obtain the power spectrum of the SCM muscle during the fatiguing process and the recovery process. The results were as follows: 1. Sustained activities of the SCM muscles were observed during sustained voluntary clenching. 2. The power spectra of the SCM muscles significantly shifted to a lower frequency as time elapsed. 3. The power spectra of the SCM muscles obtained three minutes after relaxation recovered to those of the beginning of clenching. These findings indicated that muscle fatigue may be induced in the SCM muscle during sustained voluntary clenching and that electromyographic power spectral analysis can be used as a noninvasive, objective, and quantitative index of SCM muscle fatigue.

[Role of oxidants in adhesion molecule expression and cytokine production]

Reactive oxygen intermediates such as hydrogen peroxide play an important role in the pathophysiology of acute lung injury, not only as terminal effectors, but also as second messengers in signal transduction; we studied their role in adhesion molecule expression and cytokine production. N-acetylcysteine, an antioxidant, decreased the TNF alpha-induced expression of intercellular adhesion molecule-1 on cultured epithelial cells from human bronchi (BEAS-2A), and inhibited IL-8 production by those cells. In vivo, N-acetylcysteine attenuated the sequestration of polymorphonuclear neutrophils in rat lungs caused by intratracheal lipopolysaccharide. These findings suggest that adhesion molecule expression and cytokine production in the lung are mediated by the production of reactive oxygen intermediates. Because adhesion molecules and cytokines play a crucial role in the pathophysiology of neutrophil-mediated acute lung injury, the inhibition of adhesion molecule expression and cytokine production with anti-oxidants such as N-acetylcysteine may be a useful therapeutic strategy.