bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlating 18FDG PET-CT with SPET-CT Lymphoscintigraphy Optimizes the Surgical Management of the Axilla in Patients with T2 or T3 Breast Cancer.
Authors: Soler C. , Bouteille C. , Steiner A. , Geissler B. , Grémillet E. 
Published: December 2010

Abstract
Purpose: the aim of this study was to assess the impact of 18 FDG PET-CT (FDG-PET) and sentinel lymph node (SLN) localization by lymphoSPET-CT for the surgical management of the axilla in patients with T2 or T3 breast cancer.Patients and methods: 69 patients with T2 or T3 breast cancer (20 to 40 mm) were enrolled. Both FDG-PET and lymphoSPET-CT were performed for all 69 patients. FDG-PET was performed first to analyze breast and axillary area. Two to 4 days after, SLN SPET-CT was performed (4 to 12 hours before SLN biopsy and breast surgery).When a focal accumulation of FDG was noted and related to one or more possible axillary metastases, it was compared with SLN as identified by SPECT-CT lymphoscintigraphy. Concordance and discordance of node localization were noted.Results: a focal axillary FDG uptake was found in 30 patients (43,4%). For these 30 patients, preoperative lymphoSPET-CT revealed SLN in 26. All the 26 SLNs were in the same CT location as the focal FDG uptake. SLN biopsy procedure was done in these 26 patients and revealed node metastases in 16 cases (61, 5%). Then, axillary lymph node dissection (ALND) was performed when SLN was metastatic.For the 4 patients with focal axillary FDG uptake but no SLN detected by lymphoSPET-CT, ALND was performed and revealed axillary metastases in all cases (4/4).For the 39 patients (56.6%) for whom no focal FDG uptake around axillary region was found, lymphoSPET-CT always identified SLN which was when biopsied and followed by ALND only when metastatic. 3/39 (7,5%) SLN were metastatic, 36/39 (92, 5%) SLN were healthy.So correlating 18FDG PET-CT with lymphoSPET-CT seems to be very important in cases of T2 and T3 breast cancer:1- When a focal FDG uptake is found and no SLN is found by lymphoSPET-CT, ALND is indicated.2- When a focal FDG uptake is found and is anatomically correlated with SLN as identified by lymphoSPET-CT, SLN biopsy procedure seems to be allowed and safe because node biopsy is related certainly with PET suspect node3- In case of no focal FDG uptake in axillary area, SLN biopsy procedure is probably as safe as for T1 patients.Conclusion: if these preliminary results were to be confirmed, correlating 18FDG PET-CT with SPET-CT lymphoscintigraphy will allow avoiding systematic ALND in patients with T2 or T3 breast cancer.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1024.
Predicting Axillary Lymph Node Status Using Preoperative Ultrasound-Guided Fine Needle Aspiration Cytology of Radiologically Equivocal and Abnormal Nodes.
Authors: White J. , Hogan B. , Langlands F. , Dall B. , Horgan K. 
Published: December 2010

Abstract
Introduction:The superiority of ultrasound (US) over clinical examination in the assessment of axillary nodes in patients with breast carcinoma is well recognised. Fine needle aspiration cytology (FNAC) is a quick and minimally invasive procedure to determine the status of axillary lymph nodes pre-operatively. Sentinel lymph node biopsy (SLNB) is now widely accepted as the primary axillary staging procedure in the management of early breast cancer. A negative SLNB obviates the need for more extensive axillary surgery, thereby reducing the morbidity associated with axillary node clearance (ANC) in patients with node negative breast cancer. Patients with a SLNB positive for metastasis usually require further axillary treatment, which may include completion ANC and/or radiotherapy. Improving the accuracy of pre-operative staging is desirable in reducing the number of completion ANC procedures necessitated following positive SLNB. The aim of this study is to assess the accuracy of pre-operative US-guided FNAC of radiologically equivocal or abnormal axillary lymph nodes.Method:Patients with a diagnosis of invasive breast carcinoma underwent axillary US. Those with radiologically equivocal or abnormal nodes had US-guided FNAC. Patients with a metastatic FNAC had ANC, whereas those with insufficient (i.e. no lymphocytes seen on cytology), benign or equivocal FNAC had SLNB.Results:Correlation of FNAC result and final histologyFNAC ResultN=59Node positivity N=42Inadequate54Benign173Equivocal10Suspicious11Malignant3534 The positive predictive value of suspicious or malignant cytology from a radiologically equivocal or abnormal node is 97%. The negative predictive value is 70%. US-guided FNAC used in the context has 83% sensitivity and 94% specificity.Of the five patients with radiologically equivocal or abnormal nodes and an inadequate cytology (no lymphocytes seen), four had a metastatic sentinel node biopsy.One patient had a malignant FNAC prior to neoadjuvant chemotherapy (NACT) and had benign histology on subsequent ANC. If this patient is excluded from analysis, the positive predictive value rises to 100%.Conclusion:US-guided FNAC of radiologically equivocal or abnormal axillary lymph nodes accurately predicts node positivity and can be used to avoid an unnecessary SLNB procedure.Inadequate FNAC from an equivocal or abnormal node is not sufficient evidence to recommend SLNB rather than ANC as the initial surgical axillary procedure. Patients with such findings should have a repeat US-guided FNAC before choosing to proceed with SLNB.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1031.
Non-Sentinel Lymph Node Status of Patients with T1/T2 Breast Cancer and Micrometastasis in the Sentinel Lymph Node.
Authors: Reitsamer R. , Glueck S. , Menzel C. , Peintinger F. 
Published: December 2010

Abstract
Background: Micrometastatic disease in the sentinel lymph node is still an indication for complete axillary lymph node dissection. To further reduce morbidity in breast cancer patients the omission of complete axillary lymph node dissection in patients with micrometastasis in the sentinel lymph node would be desirable.Methods: We retrieved our data-base and looked for the non-sentinel lymph node status in patients with micrometastasis in the sentinel lymph node.Patients with primary T1/T2 breast cancer and sentinel lymph node biopsy were examined for their sentinel lymph node status. Patients with a micrometastasis in the sentinel lymph node, who received a complete axillary lymph node dissection were eligible for evaluation. Patients with a micrometastisis in the sentinel lymph node, who did not receive complete axillary lymph node dissection and patients after primary systemic therapy were excluded.Results: 103 patients were eligible for evaluation. All patients had micrometastases (0,2 to 2,0mm) in the sentinel lymph nodes. In total 15/103 patients (14.6%) had a further metastasis in one or two non-sentinel lymph nodes. 8/103 patients (7.8%) had one macrometastasis in a non-sentinel lymph node with sizes from 2.1mm to 5.0mm. 3/103 patients (2.9%) had a micrometastasis in two non-sentinel lymph nodes and 4/103 patients (3.9%) had one micrometastasis in one non-sentinel lymph node.Mean age of the patients was 57 years, 34 (33%) being premenopausal and 69 (67%) being postmenopausal. 22 patients (21.4%) received immediate axillary dissection after sentinel lymph node biopsy, but 81 patients (78.6%) had a secondary axillary lymph node dissection after the final pathological report. In 19 patients (18.4%) the micrometastasis in the sentinel lymph node could be detected by frozen sections, in 77 patients (74.8%) by serial sections at 250µm in the paraffin embedded sentinel lymph node and in 22 patients (21.4%) by immunohistochemistry only.Discussion: As long as we are lacking reliable methods for predicting the non-sentinel lymph node status for patients with micrometastases in the sentinel lymph node, and as long as the impact of micrometastases in the axilla are subject of debate, axillary lymph node dissection should be performed after sentinel lymph node biopsy with micrometastases in the sentinel lymph node.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1034.
Preventive Effects of Lapatinib, a Combined EGFR 1 and EGFR 2 Inhibitor, on Methylnitrosourea-Induced ER+ and MMTV-Neu/P53 KO ER- Mammary Cancers.
Authors: Lubet R. , Bode A. , Juliana M. , Steele V. , Grubbs C. 
Published: December 2010

Abstract
Lapatinib is a small molecule TK inhibitor that blocks both EGFR 1 and EGFR 2 (Neu) in the nanomolar range. While the potential usefulness of this agent in Neu over-expressing tumors appears obvious, its potential efficacy in ER+ tumors that do not over-express Neu seems more problematic. The efficacy of lapatinib was tested in two animal models of mammary cancer; the MNU induced rat model that has ER+ mammary cancers and the MMTV-Neu/P53 KO transgenic mouse model that has Neu over-expressing ER- cancers. In the ER+ mammary model, the carcinogen (75 mg/kg BW) was administered to female Sprague-Dawley rats at 50 days of age via the jugular vein. These animals subsequently developed multiple well-differentiated mammary adenocarcinomas. Lapatinib treatment (75 or 25 mg/kg BW/day), 7x/week by gavage, was initiated five days after the carcinogen and continued until the end of the study (148 days post MNU). The high and low doses of lapatinib reduced mammary cancer multiplicity by 81% and 31%, respectively. Lapatinib at the higher dose was also an effective therapeutic agent in this model. In the MMTV-Neu/P53 KO model (over-expressed Neu under control of MMTV and heterozygous KO of P53), it was observed that lapatinib administered at a dose of 75 mg/Kg BW/day beginning when an animal was 8 weeks of age reduced cancer multiplicity by 60 %. When the short term effects of lapatinib was examined in both models, it was found that levels of phosphorylated EGFR 1 and 2, ERK and AKT, as well as the proliferation index (Ki 67), were reduced in the cancers in both models. The potential use of an agent such as lapatinib in preventing ER+ tumors is of particular interest since tamoxifen and to a lesser degree aromatase inhibitors are relatively ineffective in the prevention of ER+ tumors which over- express Neu. Supported by NCI contract HHSN261200433001C.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1043.
Is Metabolic Syndrome and Central Obesity Relevent to Biology and Progression of Postmenopausal Breast Cancer?
Authors: Healy L. , Ryan A. , Carroll P. , Ennis D. , Boyle T. , Kennedy M. , Connolly E. , Reynolds J. 
Published: December 2010

Abstract
Introduction: Obesity isassociated with both an increased risk of postmenopausal breast cancer and increased mortality rates. The mechanism is unclear, and central (visceral) obesity, insulin resistance, altered sex steroids, and altered adipokines, are mooted as possible factors. These features may cluster in the so-called Metabolic Syndrome (MetS), and the focus of this study was to systematically relate MetS to standard clinicopathological indices of breast cancer.Methods: Postmenopausal women with newly diagnosed breast cancer (n=105) were prospectively recruited. A detailed clinical and dietary history was performed, as well as body composition analysis, metabolic screen, and plasma measurement of adipokines and inflammatory markers. MetS was defined according to the International Diabetes Federation definition.Results: One hundred and five patients were recruited, the median age was 68 years (40-94) and the mean BMI was 28.3 ± 5.2 kg/m2, with 87% of patients centrally obese. MetS was diagnosed in 39% of patients, and was significantly (p&lt;0.005) associated with 13cm greater waist circumference, higher total and trunk fat mass and increased inflammation with CRP levels almost double for MetS patietns compared to non MetS (10.3 ± 2.7 V's 5.8 ± 1.0 mg/L; p=0.084).Patients with later pathological stage (II- IV) were significantly more likely to be obese (BMI) (45% Vs 16%; p=0.007), centrally obese (waist circumference) (94% Vs 72%; p=0.009), hyperglycaemic (31% Vs 12%; p=0.047), hyperinsulinaemia (19% Vs 0; p=0.026) and 51% had MetS compared to 12% for early stage disease (Path stage 0-I). Patients with node positive disease were significantly more likely to be hyperinsulaemic (22% V's 5%; p=0.030) and have MetS (50% V's 30%; p=0.028) than node negative disease.MetS was not associated with hormone receptor status or serum levels of oestradiol, progesterone, testosterone, or SHBG levels. However, SHBG levels decreased with obesity (p=0.002) and as the number of features of MetS increased (0 features: 87 ± 15.8 compared to 5 features: 32 ±2.7; p=0.003). Insulin levels increased with obesity (p=0.006), and with increasing number of features of MetS.Discussion: MetS and central obesity are common in Irish postmenopausal breast cancer patients. MetS appears to be associated with aggressive tumour biology, and this may have significance in preventive and novel treatment approaches.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1051.
Burden of Sexual Dysfunction in Women with Breast Cancer.
Authors: Goldfarb S. , Dickler M. , Fruscione M. , Sit L. , Jia R. , Kaplan J. , Barz T. , Atkinson T. , Hudis C. , Basch E. 
Published: December 2010

Abstract
Background: Sexual dysfunction is reported after chemotherapy and endocrine therapies, and causes a substantial burden on women with breast cancer. However, the prevalence and severity of sexual dysfunction in women undergoing therapy for both local and metastatic disease is not well defined. Improved understanding of sexual dysfunction may facilitate enhanced treatment and interventions in patients with breast cancer undergoing active treatment, and in survivors of this disease.Methods: We developed a survey that includes a previously validated questionnaire, the female sexual function index (FSFI), as well as an established measure of health-related quality of life (the EuroQol EQ-5D), and disease-specific items to characterize sexual dysfunction and its causes based on literature review and expert consultations. Anonymous administration of the surveys was conducted in outpatient clinic waiting areas of the Breast Cancer Center at Memorial Sloan-Kettering Cancer Center (MSKCC) and two community centers, under an IRB waiver of consent.Results: During November 2008 through May 2009, 509 women undergoing treatment for breast cancer of all stages were each queried once. The mean age was 51 (range 26-91). 87% reported current or past hormonal treatment, and 82% reported current or past chemotherapy (76% adjuvant; 24% for metastatic disease). Sexual dysfunction attributed to breast cancer or its treatment, defined as an FSFI score &lt;26, was reported by 76% of respondents. Among these women, 316/386 (82%) patients considered their sexual symptoms to be bothersome, with 247/386 (64%) noting moderate or severe levels of bother (score &gt;=5/10). Patients attributed their sexual dysfunction to chemotherapy in 318/373 (85%) of cases; to hormonal therapy in 221/298 (74%) of cases; and to surgery in 331/442 (66%) of cases. Other reported contributors to sexual dysfunction include a new diagnosis of breast cancer by 81% of respondents, anxiety by 82% of respondents, and change in relationship with a partner by 55% of respondents.Conclusion: Sexual dysfunction is prevalent in women treated for breast cancer and should be discussed with patients as a potential adverse effect of therapy. Assessment of sexual symptoms throughout treatment and beyond may facilitate the use of potential interventions such as lubricants, dilators, treatment modification, topical estrogens, and counseling. Future work includes a longitudinal prospective trial to further characterize the etiologies of these symptoms and a randomized controlled trial to evaluate interventions for sexual dysfunction.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1056.
Weight Gain Is Associated with Increased Risk of Hot Flashes in Breast Cancer Survivors on Aromatase Inhibitors.
Authors: Su H. , Su H. , Sammel M. , Springer E. , Freeman E. , DeMichele A. , DeMichele A. , Mao J. , Mao J. 
Published: December 2010

Abstract
Objective: Hot flashes in breast cancer survivors (BCS) receiving adjuvant aromatase inhibitor (AI) therapy are common, but risk factors for these symptoms are not well-defined. This study tested if body size is associated with hot flashes in BCS on AI therapy.Materials and methods: We performed a cross-sectional analysis of a cohort of postmenopausal women with Stages 0-III breast cancer receiving adjuvant AI therapy at a university hospital-based outpatient breast oncology clinic. Subjects provided patient-reported outcomes on hot flashes, current and pre-breast cancer weight and height, and additional demographic and treatment data.The primary outcome was occurrence of hot flashes. Secondary outcomes included hot flash severity and frequency. The exposures of interest were 1) current weight and 2) weight change since breast cancer diagnosis, categorized as weight loss (lost 10 pounds or more), maintenance (+/- 10 pounds), or gain (gained 10 pounds or more). Multivariable logistic regression models examined the independent association between hot flash outcomes and current weight or weight change while controlling for confounders.Results: 300 participants were enrolled at a mean age of 61 years (range 33-86) after mean duration of AI exposure of 23 months (range 1 month-9 years). 177 (59%) reported hot flashes overall, 96 (32%) reported moderate to very severe hot flashes, and 60 (20%) had at least 4 hot flashes daily. 182 (61%) experienced weight maintenance, while 81 (27%) had weight gain and 34 (11%) had weight loss. In a multivariable model, weight gain was independently associated with hot flash occurrence (OR 2.1, 95% CI 1.1-4.4) and hot flash severity (OR 2.4, 95% CI 1.4-4.9), but not hot flash frequency, after adjusting for current weight and height, age, smoking, race, prior chemotherapy and prior tamoxifen therapy. Hot flash occurrence was also significantly associated with current smoking (OR 5.1, 95% CI 1.1-24.0) and age (OR for each additional year of age 0.93, 95% CI 0.90-0.97). Current weight, alcohol use, AI type, and AI duration were not associated with any of the three outcomes.Conclusions: In an outpatient BCS population on AI therapy, weight gain is a risk factor for both hot flash occurrence and severity. Women who gained at least ten pounds since breast cancer diagnosis were two times more likely to have hot flashes than women who maintained or lost weight. These results support the thermoregulatory model of hot flashes and argue against a protective effect of body fat in this population.Support: ACS MRSG-08-110-01-CCE, ACS CCDA#-08-107-01, Pennsylvania Department of Aging
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1059.
Ethnicity, Age, and Employment Associated with Persistent Symptoms in Breast Cancer Survivors.
Authors: Fu O. , Crew K. , Jacobson J. , Greenlee H. , Yu G. , Campbell J. , Ortiz Y. , Hershman D. 
Published: December 2010

Abstract
Background: Increases in breast cancer survival rates have prompted research on the quality of life (QOL) of breast cancer survivors, but relatively few studies have included nonwhite women or women who do not speak English.Patients and Methods: We administered a survey to patients who were ≥3 months post-completion of their adjuvant treatment for stage 0-III breast cancer at Columbia University Medical Center. The questionnaire asked patients about their experience of 16 physical and emotional symptoms in the last 7 days. Univariate analysis was performed to compare differences in each symptom measure by clinical, demographic, and treatment-related factors. Factor analysis is a statistical tool used to describe the covariance relationships among many inter-related variables in terms of a few underlying factors. Maximum likelihood factor analysis of the 16 symptoms using a varimax rotation identified 4 underlying symptom clusters that we termed depression-related, chemotherapy-related, hormone-related, and pain-related based on our clinical impression of the symptom clusters. We then used analyses of variance (ANOVA) to evaluate the associations of each of the sociodemographic and clinical characteristics (race, age, income, education, language, employment, years since diagnosis, and stage) individually with each of the four factors and multiple linear regression analysis to evaluate the associations of all of the sociodemographic and clinical characteristics with each of the four factors.Results: Of 139 patients surveyed, 58 were white, 63 Hispanic, and 18 black. Most women were &lt;5 years post-diagnosis. The symptom most commonly reported was fatigue (76%). The most common severe symptom was muscle aches (40%). Most patients (70%) complained of ≥6 symptoms. Hispanic women were more likely than others to report &gt;10 symptoms (chi2 11.8, df: 4, p&lt;0.05), chemotherapy-related symptoms (beta 1.06±0.465; p&lt;0.05) and pain-related symptoms (beta 0.778±0.362; p&lt;0.05). Unemployed women were more likely than employed women to report chemotherapy-related symptoms (beta 0.472±0.228; p&lt;0.05). Women &lt;45 years old were less likely than women &gt;65 years old to report chemotherapy (beta -0.883±0.364; p&lt;0.05) and pain-related symptoms (beta -0.569±0.283; p&lt;0.05).Conclusions: The majority of women in this population of breast cancer survivors, especially those who were Hispanic, elderly, or unemployed, were burdened by symptoms, most commonly fatigue. As the number of breast cancer survivors increases, and the U.S. population diversifies, it is important to identify, characterize and alleviate perceived post-treatment physical and emotional symptoms in women of different backgrounds.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1064.