bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sentinel Lymph Node Biopsy in Patients Who Have Negative Conversion of Axillary Lymph Node after Neoadjuvant Chemotherapy for Node Positive Breast Cancer.
Authors: Lee S. , Hwang S. , Jeong J. , Kim S. , Son E. , Ryu Y. , Jung W. , Lee H. 
Published: December 2010

Abstract
Background: Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) has been currently debatable. It is possible that the tumor response to chemotherapy may alter the lymphatic drainage thus causing lower SLN identification rate and higher false negative rate. Further, the response of NAC can be different in each lymph nodes. It is doubtful whether SLNB can accurately predict axillary lymph node (ALN) status after NAC. The aim of this study to determine the identification rate, the false-negative rate, and the accuracy of SLNB after NAC for node positive breast cancer.Patients and Methods: A prospective study was initiated to evaluate the results of SLNB after NAC. From January 2007 to April 2009, 81 patients with positive axillary lymph nodes enrolled from two institutions after IRB-approved. They received NAC and then evaluated negative conversion of metastatic lymph node with both PET and breast US. All of them underwent ALN dissection after SLNB with subareolar intradermal injection technique using radioisotope. We evaluated the identification rate, false negative rate, accuracy of SLNB according to the response of chemotherapy in axillary lymph nodes (negative conversion group or remaining positive group).Results: Before the NAC, 31 patients had multiple axillary lymph node metastasis and 50 patients had single metastasis. After NAC 44 cases (54.3%) turned into negative node and 37 cases (45.7%) remained positive nodes. Total identification rate was 80.2% (65 of 81), false negative rate was 19.0% (8 of 42) and accuracy was 87.7% (57 of 65). In negative conversion group showed 84.1% (37 of 44) of identification rate, 21.1% (4 of 19) of false negative rate, 89.2% (33 of 37) of accuracy. In remaining positive group revealed 75.7% (28 of 37) of identification rate, 17.4% (4 of 23) of false negative rate, 85.7% (24/28) of accuracy. There was no statistical significant difference of identification rate, false negative rate, accuracy of SLNB among the two group after NAC (p=0.343, p=0.534, p=0.478, respectively).Conclusion: This study showed relatively low detection rate and accuracy, high false-negative rate of SLNB, even if the positive nodes changed to negative node after NAC. Thus sentinel lymph node biopsy after NAC for node positive breast cancer should be cautious. Since this study had small number of negative conversion patients, further larger prospective studies are required for more proper conclusion.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1022.
Prospective Evaluation of Pre and Postoperative Lymphoscintigraphy in Axillary Reverse Mapping (ARM) for Breast Cancer Patients.
Authors: Cusumano P. , Gomez P. , Dwelshauvers J. , Lilet H. , Nos C. 
Published: December 2010

Abstract
BackgroundThe sentinel lymph node (SLN) procedure, has been used successfully to detect lymphatic involvement. The expected reduction in morbidity and improvement in the quality of life of patients remains uncertain. In spite of this minimal invasive technique, 40 to 50 % of axilla are explored by classic axillary dissection. The aim of axillary reverse mapping (ARM) is to preserve the main lymphatic chain in relation to lymphatic arm drainage during an axillary dissection, reducing the rate of lymphedema.ObjectivesThe objective of this study is to describe a prospective comparison of pre and post axillary dissection (AD) lymphoscintigraphy, in 15 consecutive breast cancer patients.MethodsIsotope InjectionThe morning of surgery, all patients underwent isotope injection in the ipsilateral hand. Each patients received a single injection of 60 MBq (vol 0.2 ml) into the first interdigital space. The preoperative lymphoscintigraphy was performed 45 min after injection, in surgical position. An average of 2 nodes were visible in the axilla. The postoperative lymphoscintigraphy was planned before starting adjuvant treatment.Surgical TechniqueAfter having performed the lumpectomy or the mastectomy, the surgeon began the AD. The first important step was the identification of the second intercostals brachial nerve. While reserving the nerve, the dissection was carried out from medial to lateral, below the nerve. The gamma probe was then used in order to identify the first radioactive node draining the upper limb. This node was localized in the lateral pillar of the axilla. The ARM nodes were carefully preserved during the dissection with retractors placed over them to protect from inadvertent damage. After completion of AD, the axillary content was examined ex-vivo to identify at least ten nodes within the surgical specimen.ResultsThe mean age is 62.4 years (range 40-81). For all 15 patients, the mean number of axillary nodes removed by means of AD was 10.7 (range 7–14). Of all patients, 3 (87%) had metastatic involvement in the AD with an average of 1.3 (range 1– 2) nodes involved.A lymphoscintigraphic mapping concordance between pre and post, was found in 13 out 15 patients (87%).ConclusionsIsotopic ARM allows identification of radioactive nodes in the axilla in 91% of cases.The very good correlation between pre and postoperative mapping suggests a persistence of the normal LAD, and lets hope for a risk reduction of lymphodema after AD.A longterm follow up is needed to confirm these very promising preliminary results.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1025.
A Decision Tree To Predict Four or More Positive Axillary Lymph Nodes in Breast Cancer Patients with Positive Sentinel Node Biopsy: Determining Necessity for Regional Nodal Irradiation in the Absence of Axillary Dissection.
Authors: Macrorie-Fairweather R. , Albuquerque K. , Yao K. , Sinacore J. 
Published: December 2010

Abstract
Background: Regional Nodal Irradiation (RNI) is indicated for breast cancer patients with ≥4 positive axillary lymph nodes (ALN). The need for RNI is unclear for women who don't undergo axillary lymph node dissection (ALND) yet have 1-3 positive sentinel lymph nodes (SLN). In an effort to guide clinician decision-making and potentially spare patients combined toxicities of ALND and radiation, the purpose of this study was to create a decision tree of clinicopathologic variable interactions to predict patients with ≥4 positive ALN.Methods: We reviewed the records of 197 women with breast tumors &lt;5cm and 1-3 positive SLN. After ALND, patients were labeled as having &lt; 4 or ≥ 4 positive ALN. Ten clinicopathologic predictive variables were identified for analysis: patient age, size of tumor, histological type, tumor grade, number of metastatic SLN, largest SLN metastasis size, detection method, estrogen receptor, Ki67 and lymphovascular invasion (LVI). The analysis used Chi-Square Automatic Interaction Detection (CHAID SPSS), a non-parametric, stepwise “regression tree” analysis, with Bonferroni adjusted p-values to create a decision tree.Results: 141 patients had &lt; 4 and 56 had ≥ 4 positive ALN. Three variables were selected into the CHAID tree: LVI, the number of metastatic SLNs, and largest SLN metastasis size. 100% of patients (N=42) had &lt; 4 positive ALN if negative for LVI and had only 1 positive SLN with a metastasis size &lt; 0.2cm (p-value &lt; 0.0432). For patients with LVI (N=77), 13 of 14 (93%) had &lt; 4 positive ALN if the SLN metastasis size was &lt; 0.2cm (p &lt; .0014). The highest prevalence of ≥ 4 positive ALN were patients with LVI and a SLN metastasis size &gt; 0.2cm.Conclusion: The CHAID analysis more accurately predicted patients with &lt; 4 positive ALN compared to those with ≥4. The decision tree provides a new tool for the clinician to determine the necessity for RNI without ALND.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1026.
Role of Axillary Ultrasound in Defining Surgical Management of Breast Cancer Patients with Nodal Disease.
Authors: Syed A. , Garbos M. , Patel A. , Bradpiece H. , Stephanie J. 
Published: December 2010

Abstract
Background:With the introduction of Sentinel Lymph Node Biopsy, breast cancer patients with nodal disease have to undergo second surgical axillary procedure. The aim of our study was to correlate the accuracy of ultrasound in redefining surgery in breast cancer patients.Methods:The records of all breast cancer patients who underwent Axillary Lymph Node Dissection (ALND) from January 2008 to December 2008 were reviewed. Of these, patients who had pre operative axillary ultrasound and/or fine needle aspiration cytology were included. All ultrasound were performed by the radiologist with special interest in breast imaging at our breast centre. Comparison of the ultrasound and FNA findings with ALND findings was performed.Results:Seventy Five patients had axillary ultrasound during this period. Twenty five patients (32.3%) had abnormal ultrasound findings. Of these, 22 patients had positive surgical staging and three patients had negative surgical staging. Ten of the abnormal axilla had FNAC done. Of these, seven patients had metastatic cells and all of these patients have finally proven to have positive axillary lymph nodes. Of the fifty patients (67.7%) with normal axilla, 34 patients had negative surgical staging and 16 had positive staging The sensitivity of ultrasound axilla was 57.89%, and specificity was 96%. The positive predictive value was 88% and the negative predictive value was 78.57%Discussion:Ultrasound examination of axilla is a safe and fast method of assessing the lymph nodal status in the preoperative staging of axilla. The results of our study are mostly in agreement with previous published studies. This will reduce the number of patients having to undergo a second axillary procedure, hence saving resources both financially and operating time. It will reduce the number of hospital admissions for the patient; improve cost effectiveness and the patient pathway. We therefore recommend routine axillary ultrasound with FNAC of suspicious/pathological nodes to avoid sentinel node procedure i.e., proceed directly to axillary clearance.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1033.
In Which Patients Can We Accurately Evaluate the Status of Axillary Lymph Node Metastases Using Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy?
Authors: Yagata H. , Nakamura S. , Tsugawa K. , Yamauchi H. , Nakano E. , Yoshida A. , Mori M. , Kajiura Y. , Onoda T. , Takamoto Y. , Kojima Y. , Kitano A. , In R. , Matsuda N. 
Published: December 2010

Abstract
Background: Several studies have reported on the feasibility of sentinel lymph node (SLN) biopsy after neoadjuvant chemotherapy (NAC) in breast cancer patients. However, the accuracy has been variable depends on reports. We would like to determine in which patients we can accurately evaluate the status of axillary lymph node metastases using SLN biopsy after NAC in cytology-proved positive lymph node patients.Patients and Methods: Ninety-five cytology-proved node positive patients underwent SLN biopsy followed by axillary dissection between February 2007 and April 2009. All of those had clinical response in primary breast tumor detected by MRI after NAC.Results: SLN biopsy after NAC was successfully performed 81 out of 95 patients (85.3%). Among those 81 patients, lymph node metastases after NAC were identified by final pathology in 51 patients (63.0%). Eight of those 51 patients with lymph node metastases showed negative SLN biopsy. Therefore false negative rate was 15.7%. Patients who were diagnosed ER negative from the core needle specimen prior to NAC or had clinical CR by MRI did not showed any false negative by SLN biopsy. SLN were identified in 27 out of those 30 patients (90%). Final pathology after NAC revealed 7 patients with lymph node metastases and all of them had positive SLN. Twenty out of 27 (74.1%) patients revealed no evidence of metastases in both SLN and non-SLN.Discussion: After NAC, the false negative rate of SLN biopsies was high (15.7%) in cytology –proved lymph node-positive breast cancer patients. However, this study suggested that SLN biopsy after NAC may be performed accurately in patients who had ER negative tumor or CR by MRI, and that 20 out of 95 patients (21%) could possibly avoid axillary dissection after NAC. These results need to be confirmed by larger studies for the selected patients.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1036.
Sulindac Sulfide Selectively Induces Apoptosis of Human Breast Tumor Cells by Inhibiting PDE5A, Elevating cGMP, and Activating PKG.
Authors: Tinsley H. , Gary B. , Keeton A. , Reynolds R. , Piazza G. , Piazza G. 
Published: December 2010

Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2 selective inhibitors display promising antineoplastic activity, but the gastrointestinal, renal, and cardiovascular toxicities that result from COX inhibition limit their clinical utility for cancer chemoprevention. Previous studies suggest that the pro-apoptotic activity of these drugs may be due to a COX-independent mechanism involving cyclic guanosine monophosphate (cGMP) phosphodiesterase (PDE) inhibition. However, the specific PDE isozyme(s) responsible has not yet been identified. Here we used the NSAID sulindac sulfide (SS) to further study cGMP PDE as a potential molecular target of the NSAIDs for breast cancer chemoprevention. SS inhibited growth and induced apoptosis of human SK-BR-3 and MDA-MB-231 breast tumor cells, while normal human mammary epithelial cells (HMEC) were less sensitive. SS also inhibited cGMP PDE activity from tumor cell lysates at concentrations comparable to those required for apoptosis, while appreciably higher concentrations were necessary to inhibit activity from HMEC lysates or cAMP PDE activity from any of the cell lysates. Additionally, SS increased intracellular cGMP concentrations and induced protein kinase G (PKG) activity in MDA-MB-231 cells as determined by ELISA and increased levels of phosphorylated VASP, a known PKG substrate, respectively. Moreover, pretreatment with the guanylyl cyclase inhibitor LY83583 desensitized the breast tumor cells to the growth-inhibitory activity of SS, likely by suppressing intracellular cGMP levels. The guanylyl cyclase activator NOR-3 and the cGMP PDE inhibitors MY5445 and trequinsin inhibited tumor cell growth, while the adenylyl cyclase activator forskolin and other PDE inhibitors had no effect. HMEC were found to express several cGMP hydrolyzing PDE isozymes (PDE1, 5, and 9), while the breast tumor cells expressed predominantly PDE5, which was confirmed to be sensitive to inhibition by SS using a recombinant enzyme. This work demonstrates that inhibition of PDE5A, elevation of cGMP, and activation of PKG are responsible for the pro-apoptotic effects of SS in human breast tumor cells and that differential expression of PDE isozymes between normal and tumor cells may explain the tumor selectivity of NSAIDs. These data also suggest that it may be feasible to develop NSAID derivatives with increased selectivity for inhibiting PDE5 and decreased COX-inhibitory activity, which would potentially improve safety and efficacy for breast cancer chemoprevention.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1041.
Immunohistochemical Phenotype after 20-Year Follow-Up of the Royal Marsden Tamoxifen Breast Cancer Prevention Trial (RMTBCPT).
Authors: Detre S. , Ashley S. , Tidy A. , Smith I. , Powles T. , Dowsett M. 
Published: December 2010

Abstract
Background: 20-yrs after starting the randomized, double-blind RMTBCPT (13-year median follow-up) 186 women developed invasive breast cancer, 82 on tamoxifen and 104 on placebo1. There was a significant reduction in the incidence of invasive ER+ but not ER- breast cancer that was significant after but not during the 8yr treatment period. The phenotype of ER+ breast cancer is highly variable. We have therefore assessed PgR, HER2, EGFR and Ki67 expression in as many as possible of these tumours.Methods: Tumour blocks were available on 154 participants, 65 on tamoxifen and 89 on placebo a similar distribution to the whole population. Staining was conducted using the following antibodies: ER, clone 6F11(Vector); PgR, clone 16 (Vector); HER2, HercepTest + K5207 (Dako), FISH PathVysion (Abbott) for IHC 2+ cases; EGFR, clone 31G7 (Invitrogen); Ki67 clone Mib1(Dako). ER and PgR were quantified as H-scores, HER2 and EGFR as + or –, and Ki67 as % cells staining.Results: There were 47 and 18 ER+ and ER- tumours in the tamoxifen arm vs 76 and 13 in the placebo arm, showing a 37% (95% CI 10- 57%, p=0.01) reduction of ER+ tumours which was essentially the same as that in the whole population1.There were 38 and 27 PgR+ and PgR- tumours in the tamoxifen arm vs 58 and 31 in the placebo arm, showing a 33% (95% CI 0-56%, p=0.05) reduction of PgR+ tumours. The distribution of ER/PgR tumours according to arm and time on trial at tumour diagnosis is shown in the table (there were no ER-PgR+ cases).The decrement in ER+ tumours was predominantly in ER+PgR+ cases after 8yrs but extended to ER+PgR- cases. It is important to note that the post 8yr tumour phenotype cannot be affected by continued exposure to tamoxifen. ER levels were significantly lower in the tamoxifen-treated group even among tumours presenting as ER+ (median H-score 123 vs 161, p=0.02). There were 9 and 6 HER2+ and 11 and 12 EGFR+ cases in the tamoxifen and placebo arms, respectively (p=NS for both). The mean (95%CI) levels of Ki67 were 8.4% (6.3-11.1) and 8.5% (6.8-10.6) in the 2 arms, respectively.Discussion: The decrement in ER+ tumours in the tamoxifen-treated women was restricted to the post-treatment period and was similar to that seen in the overall population1. Among the ER+ group there was a similar proportional reduction of PgR+ and PgR- tumours by tamoxifen.There was no evidence of enhanced HER2 or EGFR expression or increased proliferation in tumours developing in the tamoxifen arm but ER expression was reduced even among ER+ tumours.1Powles et al, JNCI, 2007;99:283-90. Time on trialPlaceboTamoxifenER+PgR+&lt;8 years2622ER+PgR+&gt;8 years3216ER+PgR-&lt;8 years106ER+PgR-&gt;8 years83ER-PgR-&lt;8 years711ER-PgR-&gt;8 years67All&lt;8 years4339All&gt;8 years4626 Supported by the Da Costa International Fund for Breast Cancer Prevention
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1046.
Prognostic Effect of Sesrum 25 Hydroxyvitamin D Levels in Breast Cancer Patients.
Authors: Kim H. , Lim W. , Son B. , Kim M. , Jeong K. , Kim S. , Ahn J. , Gong G. , Kim H. , Yeom C. , Ahn S. 
Published: December 2010

Abstract
BackgroundThere is increasing evidence that vitamin D has been linked to breast cancer risk, but prognosis effect are unknown. We investigated the possible association between vitamin D and breast cancer prognosis by comparing serum vitamin D levelMethodsFrom June to December 2006, serum 25 OHD were measured in 310 Korean women with breast cancer at the Asan Medical Center. Clinical, Pathologic, and dietary data were accessed to examine prognostic effects of serum 25 OHDResultsMean age was 48.7 years, mean serum 25OHD was 31.4±16.1ng/ml. 25OHD levels were deficient(&lt;20ng/ml) in 24.2%, insufficient (20-29ng/ml) in 30.6%, and sufficient(30-150ng/ml) in 24.0%. Mean follow up was 30 months: 31 had recurrences. Women with deficient 25 OHD levels had an increased risk of recurrence(HR=2.93;95% CI=1.27 to 6.77) compared with those with sufficient levels. 25OHD levels were inversely associated with prognosis of hormone receptor positive tumors, but not with hormone receptor negative tumors(HR=5.73 95CI=1.82 to 18.06 for hormone receptor positive tumor, HR=1.142, 95%CI =0.33 to 3.92 for hormone receptor negative tumor). The association remained after individual adjustment for age, tumor size, nodal status, estrogen receptor status (HR=4.13 95%CI=1.77 to 9.61) .ConclusionVitamin D deficiency may be associated with poor outcomes in hormone receptor positive breast cancer patients.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1052.
Deleterious Effect of Chemotherapy on Measures of Insulin Resistance in Patients with Newly-Diagnosed Invasive Breast Cancer.
Authors: Makari-Judson G. , Katz D. , Barham R. , Mertens W. 
Published: December 2010

Abstract
Background: Women treated with early stage breast cancer often gain weight in the two years following diagnosis, with adjuvant chemotherapy, younger age, lower body mass index (BMI) and pretreatment menopausal status being associated factors (Breast J 2007; 13:258). The effect of insulin resistance on treatment-related weight gain, and of treatment on measures of insulin resistance, are unclear.Purpose: To prospectively study weight gain in women receiving adjuvant therapy for early stage breast cancer and assess changes in body mass index, body composition, and explore the relationship between markers of insulin resistance, cancer therapy, exercise and weight gain.Methods: Prospective, observational study of non-diabetic women with early-stage breast cancer receiving adjuvant chemotherapy and/or hormonal therapy. Fasting insulin, glucose, and triglycerides, weight, BMI, waist and hip circumference were obtained at baseline before adjuvant therapy, and at 6, and 12 months. Patients completed nutrition and exercise logs using the Nutritionist-Pro program. Insulin resistance was calculated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Waist/hip ratio (WHR) was used as a surrogate for percent body fat.Results: Complete data available for 95 patients are reported regarding weight change at 6 months (mean 0.4 kg, 95%CI -0.3, 1.0; p=.23 compared to baseline) and 12 months (0.9 kg, 95%CI 0.4, 1.8, p=.04 compared with baseline). Mean baseline HOMA-IR was 2.3 (95%CI 1.9, 2.7); mean baseline WHR was 0.82 (95%CI 0.81, 0.84). Six-month HOMA-IR tended to increase (by mean 0.34, p=.06) as did glucose/insulin ratio (p=.05). Waist measurement (p=.96) and WHR (p=.52) were unchanged. Chemotherapy-treated patients exhibited adverse changes compared with others (mean change for chemotherapy-treated and no chemotherapy for HOMA-IR: 0.53 vs. -0.64, p=.005; glucose/insulin: -2.1 vs. 2.7, p=.003; waist: 0.37 vs. -1.94 cm, p=.08; WHR: 0.001 vs. -0.024, p=.06). Age, BMI, hormonal therapy, or types of breast surgery were not associated with significant changes. Exercising patients demonstrated lower HOMA-IR and WHR, and greater glucose/insulin ratios at baseline, but exercise (aerobic, strength, or any exercise) was not associated with significant change at 6 and 12 months for any of these variables. While differences disappeared at 12 months despite further weight gain repeated measures analysis of variance confirmed the effect of chemotherapy over time for HOMA-IR (p=.048), glucose/insulin (p=.038) and WHR (p=.050).Conclusions: These preliminary data suggest that patients completing chemotherapy within 6 months of baseline appear to experience at least short-term changes in metabolism suggestive of insulin resistance. These adverse changes may help explain weight gain associated with adjuvant chemotherapy, and merit further prospective study.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1054.