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en: Intratumoral heterogeneity, treatment response, and survival outcome of ER-positive HER2-positive breast cancer

en: ER+HER2+ breast cancer requires most types of systemic therapies perioperatively. However, treatment resistance is often experienced. The current study investigated the predictive and prognostic value of intratumoral heterogeneity and conventional clinicopathological factors in patients with ER+HER2+ breast cancer. This research included two patient cohorts with ER+HER2+ breast cancer. Cohort A included patients who underwent surgery without neoadjuvant chemotherapy (NAC). Cohort B comprised patients who received NAC followed by surgery. Intratumoral heterogeneity was assessed via ER and HER2 double staining, and the number of cells stained with different patterns of ER and HER2 was counted. In total, 11 of 92 tumors in cohort A and four of 45 tumors in cohort B consisted exclusively of double-positive (ER+ and HER2+) cells (homogeneous). The rest had different combinations of cells (heterogeneous). The pathological complete response (pCR) rates differed based on tumoral cell components but not intratumoral heterogeneity. The pCR rate of tumors with ER-HER2+ cells but without HER2- cells was higher than that of others (45.5% vs 4.3%; p = 0.0013). Low ER and PgR Allred scores indicated better pCR rates than high scores (p = 0.0005 and 0.024, respectively). Multivariate analysis showed that the ER Allred score and cell component of ER-HER2+ cells without HER2- cells were independent predictors of pCR (p = 0.0055 and 0.0081, respectively). In cohort B, posttreatment Ki67, but not pCR, was a prognostic factor of DFS and OS (p = 0.028 and 0.017, respectively). The prognostic value of combined posttreatment Ki67 and pCR was superior to that of either alone. Combined pCR and posttreatment Ki67 had an independent prognostic value for DFS and OS (p = 0.0068 and 0.0101, respectively). In ER+HER2+ breast cancer, the presence of ER-HER2+ cells without HER2- cells was independently associated with pCR. Combined posttreatment Ki67 and pCR can be more precise in predicting prognosis than pCR alone.

en: Cancer Medicine

ja: Cancer Medicine


en: Absolute Lymphocyte Count Changes During Neoadjuvant Chemotherapy are Associated With Prognosis of Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Patients

en: Some reports have shown that absolute lymphocyte count (ALC) is associated with prognosis in breast cancer; however, the impact of ALC changes remains unclear. This study aimed to investigate the relationship between ALC changes during neoadjuvant chemotherapy for human epidermal growth factor receptor-2 (HER2)-positive breast cancer patients and disease prognosis. This retrospective cohort study January 2010 to September 2020) included patients diagnosed with HER2-positive breast cancer and treated with trastuzumab-based neoadjuvant chemotherapy. The ALC ratio was defined as the ALC value after administration of the anti-HER2 drug divided by the ALC value before administration. The optimal ALC ratio cut-off value was identified using the receiver operating characteristic curve analysis and Youden's index. The relationship between the ALC ratio and disease-free survival was assessed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Data from a total of 100 HER2-positive breast cancer patients were analyzed. The cut-off value of the ALC ratio was set as 1.142. The median follow-up period was 52.0 (range: 5.1-123.7) months. The 5-year disease-free survival rates were 88.4% and 60.9% in the high-and low-ALC ratio groups, respectively, and were significantly higher in the high-ALC ratio group (p = .0031). The ALC ratio was an independent prognostic factor in multivariate Cox proportional hazards analysis (p = .0032). HER2-positive breast cancer patients with a higher ALC ratio during trastuzumab-based neoadjuvant chemotherapy may have a better prognosis than their counterparts.

en: Clinical Breast Cancer

ja: Clinical Breast Cancer


en: Axillary lymphangioma that developed following COVID-19 vaccination: a case report

en: Extensive vaccination programs are being implemented worldwide for coronavirus disease 2019 (COVID-19). With the spread of vaccination, swelling of the lymph nodes after vaccination is frequently seen. We encountered a patient who developed left axillary lymphadenoma following vaccine administration. The patient was a Japanese woman in her 80 s who had previously undergone surgery for right breast cancer. She received two injections of the Pfizer-BioNTech COVID-19 vaccine in her left arm. Approximately 3 months later, she complained of left axillary swelling, and imaging resulted in a diagnosis of left axillary lymphangioma. In accordance with the patient's wishes, we performed axillary mass resection. The pathological diagnosis was lymphangioma. Our examination findings indicated that congestion of the axillary lymph vessels might have been caused by upper-arm injections of the COVID-19 vaccine.

en: Surgical Case Reports

ja: Surgical Case Reports


en: Increased 18F-FDG Uptake in the Axillary Lymph Nodes of Vaccinated Side Associated with COVID-19 Vaccination

en: A 50-year-old female patient underwent (fluorine-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) following modified radical mastectomy for cancer of the left breast. Ten days before the PET/CT, the coronavirus disease-2019 (COVID-19) vaccine was injected intramuscularly into the right deltoid muscle. Increased (F-FDG uptake of maximum standardized uptake value (11.0) was observed in the lymph nodes of the right axilla, which had not been observed in the previous PET/CT. The size of the oval-shaped lymph nodes was up to approximately 11×9 mm; however, it was larger than that observed on the previous PET/CT. We contemplate that the increased (F-FDG uptake was a reactive change in the lymph nodes associated with the COVID-19 vaccine.

en: Molecular Imaging and Radionuclide Therapy


en: False-negatives due to poor specimens can be prevented based on the macroscopic findings for breast Vacuum-Assisted Biopsy specimens

en: Ultrasound-guided breast tissue biopsy is an essential technique for diagnosing breast disease, but sample errors reduce its accuracy. This study investigated whether the histopathological results can be inferred from the macroscopic findings for Ultrasound-guided breast Vacuum Assisted Biopsy (VAB) specimens. Biopsy specimens from 101 patients who underwent mammary gland VAB were photographed with a smartphone, and the relationships between the macroscopic findings and the pathological results were examined. A significant difference was observed with regard to the presence/absence of turbidity: malignancy was detected in 33/37 (89%) specimens with turbidity and in 2/47 (4%) cases without turbidity (p<0.001). A significant difference was also observed regarding the surface properties:malignancy was detected in 14/70 (19%) smooth specimens and in 24/29 (83%) rough specimens (p<0.001). Also, malignancy was detected in 11/13 (85%) specimens with white spots, and the difference was significant (p<0.001). In addition, the characteristics of intraductal papilloma, fibroadenoma, and mastopathy could be confirmed by macroscopic findings. When needle-biopsy of a lesion that is targeted for resection yields macroscopic findings that match the predicted histopathological findings, it can be thought that the biopsy had been properly performed. This means that false-negatives due to poor specimens can be prevented. J. Med. Invest. 69 : 51-56, February, 2022.

en: The Journal of Medical Investigation : JMI


en: Drug-induced interstitial pneumonia during perioperative chemotherapy for breast cancer

en: Drug-induced interstitial pneumonia (DIP) that occurs during chemotherapy for breast cancer is a rare but a serious adverse event. Treatments of DIP requires interruption of breast cancer treatment, which may affect the patient's prognosis. However, there are few reports which discuss DIP during breast cancer treatments. Purpose of this report is to make clear how DIP occurred and influenced breast cancer treatment in our hospital. A total of 74 patients who started perioperative chemotherapy in Tokushima Municipal Hospital for breast cancer from January 2019 to December 2020 were evaluated for DIP. Patients' and tumors' characteristics, and regimens which caused DIP were investigated. The clinical courses of the DIP patients were also followed up. Twelve of the 74 patients developed DIP. All 12 patients had histories of cyclophosphamide administration;however, the causative drug could not be determined. Ten of the 12 patients were treated with steroids, and all the patients recovered ultimately from the interstitial pneumonia. While chemotherapy was administered in six patients after mild DIP, no relapse of pneumonia was observed. DIP during perioperative chemotherapy for breast cancer was resolved with appropriate treatment. Patients were able to resume breast cancer treatment with minimal interruption. J. Med. Invest. 69 : 107-111, February, 2022.

ja: The Journal of Medical Investigation : JMI


en: HER2陽性乳癌患者における術前化学療法開始前の総リンパ球数は予後予測の指標となり得る

en: Purpose : Several studies have shown that peripheral hematologic parameters, such as the absolute lymphocyte count(ALC)and neutrophil to lymphocyte ratio(NLR)can predict the prognosis for malignant tumor. We investigated the relation of these parameter and prognosis before neoadjuvant chemotherapy for human epidermal growth factor receptor-2(HER2)-positive breast cancer patients. Methods : From April 2009 to March 2019, 85 patients diagnosed with HER2‐positive breast cancer and treated with trastuzumab-based neoadjuvant chemotherapy were included in this retrospective cohort study. The optimal cut-off for the NLR and ALC was identified using the receiver operating characteristic(ROC)curve analysis and Youden's index. Results : The median age of patients at the start of treatment was 58．9(range 32‐81)years. The median follow-up time for HER2-positive breast cancer patients was 52．0(range:9．8‐114．3)months. In this period, 11 patients developed recurrence. The low-ALC group showed better disease free survival than the high-ALC group(p=0．0482). There was no significant difference in disease free survival between the low- and high-NLR groups. Conclusion : ALC before neoadjuvant chemotherapy may be a predictor of prolonged disease free survival in HER2‐positive breast cancer patients.

en: Shikoku Acta Medica

ja: 四国医学雑誌


en: Comprehensive Interventions for Building a Better Regional Cooperation for Cancer Patients

ja: より良いがんの地域連携体制構築のための包括的な取り組み

en: Objectives : We introduce our comprehensive interventions for building a better regional cooperation for cancer patients. Methods : We have made a questionnaire survey for community physicians asking whether they can accept cancer patients and what types of medical treatments they can provide. Based on the questionnaire responses, we visualized the information, developed a new critical pathway, and improved the system in a basic hospital. Results : We first organized the information obtained from the questionnaire responses and uploaded the organized information to the basic hospital's homepage for public access. We then developed a new critical pathway for the cooperation among community physicians considering the prophylactic administration of a granulocyte-colony stimulating factor (G-CSF) formulation for treating cancer patients. This treatment was subsequently applied to four patients. Additionally, a community physician was matched with each patient by a medical social worker during the patients' hospitalization. We improved the basic hospital's simple electronic medical record system to reduce the physicians' workloads. As a result, the document creation could be completed within one minute, and so they could relate to approximately 10 times larger number of cases. Conclusions : Satisfactory cancer treatments can be provided for patients by building the better regional cooperative relationships and dividing the roles with community physicians in an earlier time.

ja: 目的:より良いがんの地域連携体制を構築するための包括的な取り組みについて紹介する．方法:かかりつけ医を対象に行った，がん患者の連携の可否と役割分担できる診療内容に関するアンケート結果をもとに，情報の可視化，新たな連携クリティカルパス(連携パス)の導入，拠点病院内の環境整備を行った．結果:まず，アンケート結果の情報を整理し，誰もがアクセスできるよう病院ホームページにアップして可視化した．さらに，予防的G-CSF(Granulocyte-Colony Stimulating Factor)投与連携パスを運用し，少数だが4例に適用した．加えて，入院中に医療ソーシャルワーカーが介入してかかりつけ医を決定し，文書作成を1分以内に完遂できる簡便な電子カルテ運用にして医師の作業負担を減らし，連携件数を約10倍増加させた．結語:より早期から緊密に情報交換し，役割分担することで，患者にとって満足度の高いがん医療を提供できる．今回の取り組みは，より良い連携体制構築に寄与すると考える．

en: Journal of Japan Surgical Association

ja: 日本臨床外科学会雑誌


en: [ .N-1 Study].

ja: Ⅲ. N-1 Study

en: Japanese Journal of Cancer and Chemotherapy

ja: 癌と化学療法


en: A case of juvenile fibroadenoma arising from axillary accessory mammary gland

ja: 腋窩副乳発生と考えられる若年性線維腺腫の1例

en: A case is20years old woman. She had previously noticed a mass in the left axilla. The mass grew, so she went to the hospital. Ultrasonography revealed a 71 × 51 mm well-defined tumor in the left axilla. We suspected a benign tumor but could not rule out axillary lymph node metastasis or accessory breast cancer. The findings of fine needle aspiration cytology suggested fibroadenoma or phyllodes tumor. Although we diagnosed fibroadenoma by needle biopsy, a definitive diagnosis was made by tumor resection because it is located in the axilla and large in size, and other diseases such as phyllodes tumors can be distinguished. The histopathological diagnosis of the excised specimen was juvenile fibroadenoma. We report a case of juvenile fibroadenoma arising from the axillary accessory mammary gland.


en: Breast-conserving surgery without radiation in elderly women with early breast cancer

en: Irradiation after breast-conserving surgery (BCS) decreases the incidence of ipsilateral breast tumor recurrence (IBTR) and breast cancer-related death. However, daily radiation treatments are burdensome to elderly patients, whose risk of IBTR is relatively low. Since 2001, we have offered BCS without radiation to patients meeting our selection criteria. This study assessed the prognosis of the patients who chose this option. Between 2001 and 2014, 203 patients met the selection criteria: aged ≥60 years; pathologically node-negative, hormone-positive breast cancer; a negative surgical margin; and no lymphovascular invasion. Among these patients, 84 and 119 underwent BCS with or without radiation, respectively. IBTR, overall survival (OS), and breast cancer-specific survival (BCSS) were evaluated. The median follow-up duration was 6.2 years. There were no significant differences in tumor size or the number of patients with adjuvant therapy between the groups. The 5-year IBTR rates were 0.9% and 1.6% in the non-irradiated and irradiated groups, respectively (p = 0.308). The 5-year OS rates were 94.1% and 98.7% (p = 0.391). Similarly, the 5-year BCSS rates were 97.2% and 98.7% (p = 0.812). It is suggested that the omission of irradiation could be an option for elderly breast cancer patients who satisfy our criteria.

en: Surgical Oncology

ja: Surgical Oncology