AIM:TAC chemotherapy is a standard adjuvant treatment for early-stage breast cancer, with G-CSF recommended for preventing febrile neutropenia (FN). This study investigates the optimal initiation timing for daily filgrastim to prevent FN in patients undergoing TAC chemotherapy, a subject not fully explored in existing guidelines. METHODS:Sixty breast cancer patients receiving adjuvant TAC chemotherapy were randomly assigned to start daily filgrastim either on Day 2 (Day 2 group, n = 30) or Day 5 (Day 5 group, n = 30). The primary outcome was the incidence of FN. Secondary outcomes included the duration of neutropenia treatment and the neutropenia profile. RESULTS:Patients underwent 349 cycles of TAC chemotherapy (173 cycles in Day 2 group and 176 cycles in Day 5 group). The incidence of FN was significantly lower in the Day 2 group (6.4%, 11/173) compared to the Day 5 group (22.2%, 39/176, p < 0.0001). Additionally, the mean ± SD duration of filgrastim treatment was longer (8 ± 1 vs. 6 ± 1 days, p < 0.0001), and the duration of severe neutropenia was shorter (3 ± 1 vs. 4 ± 1 days, p = 0.001) in the Day 2 group. CONCLUSION:Initiating filgrastim on Day 2 of TAC chemotherapy significantly enhances its effectiveness in preventing FN compared to starting on Day 5. These findings support early intervention and sustained treatment to optimize toxicity management in adjuvant TAC chemotherapy.

506 Background: The ASTRRA trial previously demonstrated that adding ovarian function suppression (OFS) to tamoxifen (TAM) showed consistent disease free survival (DFS) benefit at 8-yr follow-up analysis in premenopausal women with hormone-receptor (HR)–positive breast cancer who remain premenopausal or resume menstruation after chemotherapy. Here, we aimed to update the survival outcomes and identify patients most likely to benefit from OFS to tailor clinical decision-making. Methods: A total of 1,282 premenopausal women were randomized 1:1 to receive either 5 years of TAM alone (TAM-only) or 5 years of TAM with OFS for 2 years (TAM + OFS). The primary endpoint was DFS, and the secondary endpoint was overall survival (OS). For the HER2-negative cohort, a composite risk score (range: 0–5) for breast cancer-free interval (BCFI) was calculated based on tumor size, nodal status, and tumor grade using a Cox regression model. The impact of OFS was analyzed by composite risk score and stratified by age. The events for BCFI were defined as local, regional, or distant recurrence; invasive contralateral breast cancer; or death resulting from breast cancer as the first event. Results: With a median follow-up of 117.6 months, the 10-year DFS rate was 83.7% in the TAM + OFS group compared to 75.9% in the TAM-only group (hazard ratio [HR], 0.68; 95% CI, 0.53-0.87). Meanwhile, there were no significant differences in 10-year OS: 94.6% in the TAM + OFS vs. 93.2% in the TAM-only group (HR, 0.79; 95% CI, 0.50-1.27). In the 776 patients with HER2-negative breast cancer, there were no significant differences in the distribution of age group ( P = .320), tumor size ( P = .572), lymph node status ( P = .577), or histologic grade ( P = .249) between TAM + OFS and TAM-only groups. Worse 10-year BCFI was significantly associated with younger age ( < 40 vs. 40-45 years, P = .026), larger tumor size (≥ 2cm vs. < 2cm, P < .001), lymph node positivity (positive vs. negative, P < .001), and aggressive histologic grade (III vs. II vs. I, P = .006), respectively. Among patients with a high composite risk score (4–5, n = 282, 36.3% of the HER2-negative cohort), the 10-year BCFI was significantly improved with OFS: 76.6% in the TAM + OFS group vs. 65.7% in the TAM-only group (HR, 0.62; 95% CI, 0.40–0.98). This benefit was particularly pronounced in patients aged 40–45 years. Conclusions: We demonstrated the consistent benefit of adding OFS for 2 years to TAM in improving 10-year DFS. In patients with HR-positive/HER2-negative breast cancer and a high composite risk score, the addition of TAM plus OFS resulted in a 10.9% improvement in the 10-year BCFI, suggesting this approach may be beneficial, especially for those aged 40-45 years. Clinical trial information: NCT00912548 .

Metastasis is a leading cause of mortality in breast cancer and is critically influenced by cell–extracellular matrix (ECM) interactions, mechanical forces, and cellular motility. In this study, we present a cell surface engineering approach using tris(2-carboxyethyl)phosphine (TCEP), a biocompatible thiol-modifying agent, to modulate the biomechanical behavior of breast cancer cells. TCEP treatment increased surface thiol availability, enhanced phosphorylation of focal adhesion kinase (FAK), and promoted the elongation of pFAK-positive focal adhesions, along with cytoskeletal remodeling and stronger cell–ECM adhesion. These molecular and structural changes corresponded with significantly reduced migration and invasion of MCF7 and MDA-MB-231 cells. Using traction force microscopy (TFM), we further observed increased intracellular tension and traction stress, providing quantitative insight into how surface modification regulates mechanotransduction. These findings highlight the potential of cell surface thiol engineering to control cancer cell adhesion and motility, providing a platform for future identification of clinically applicable redox-modulating agents.

ImportanceWhile nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM).ObjectiveTo examine the differences in postoperative complications between C-NSM and M-NSM.Design, Setting, ParticipantsThis was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024.ExposuresM-NSM or C-NSM.Main Outcomes and MeasuresClinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications.ResultsThere were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03).Conclusions and RelevanceThe similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.

Abstract Background Since it has been found that the maximum metabolic activity of a cancer lesion shifts toward the lesion edge during cancer progression, normalized distances from the hot spot of radiotracer uptake to tumor centroid (NHOC) and tumor perimeter (NHOP) have been suggested as novel F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters that can reflect cancer aggressiveness. This study aimed to investigate whether NHOC and NHOP parameters could predict pathological response to neoadjuvant chemotherapy (NAC) and progression-free survival (PFS) in breast cancer patients. Methods This study retrospectively enrolled 135 female patients with breast cancer who underwent pretreatment FDG PET/CT and received NAC and subsequent surgical resection. From PET/CT images, normalized distances of maximum SUV and peak SUV-to-tumor centroid (NHOCmax and NHOCpeak) and -to-tumor perimeter (NHOPmax and NHOPpeak) were measured, in addition to conventional PET/CT parameters. Results Of 135 patients, 32 (23.7%) achieved pathological complete response (pCR), and 34 (25.2%) had events during follow-up. In the receiver operating characteristic (ROC) curve analysis, NHOCmax showed the highest area under the ROC curve value (0.710) for predicting pCR, followed by NHOCpeak (0.694). In the multivariate logistic regression analysis, NHOCmax, NHOCpeak, and NHOPmax were independent predictors for pCR (p < 0.05). In the multivariate survival analysis, NHOCpeak (p = 0.026) was an independent predictor for PFS along with metabolic tumor volume, with patients having higher NHOCpeak showing worse PFS. Conclusion NHOCpeak on pretreatment FDG PET/CT could be a potential imaging parameter for predicting NAC response and survival in patients with breast cancer.

This study investigated whether the textural features of peritumoral adipose tissue (AT) on [18F]fluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) can predict the pathological response to neoadjuvant chemotherapy (NAC) and progression-free survival (PFS) in breast cancer patients. We retrospectively enrolled 147 female breast cancer patients who underwent staging FDG PET/CT and completed NAC and underwent curative surgery. We extracted 10 first-order features, 6 gray-level co-occurrence matrix (GLCM) features, and 3 neighborhood gray-level difference matrix (NGLDM) features of peritumoral AT and evaluated the predictive value of those imaging features for pathological complete response (pCR) and PFS. The results of our study demonstrated that GLCM homogeneity showed the highest predictability for pCR among the peritumoral AT imaging features in the receiver operating characteristic curve analysis. In multivariate logistic regression analysis, the mean standardized uptake value (SUV), 50th percentile SUV, 75th percentile SUV, SUV histogram entropy, GLCM entropy, and GLCM homogeneity of the peritumoral AT were independent predictors for pCR. In multivariate survival analysis, SUV histogram entropy and GLCM correlation of peritumoral AT were independent predictors of PFS. Textural features of peritumoral AT on FDG PET/CT could be potential imaging biomarkers for predicting the response to NAC and disease progression in breast cancer patients.

Purpose:Phyllodes tumors are similar to fibroadenomas in imaging and in pathological characteristics and are difficult to identify preoperatively. The purpose of this study was to analyze the recurrence rate after excision stratified by the surgical margin width and to propose and emphasize the "wait and watch" treatment strategy for benign phyllodes tumors.Methods:We performed a retrospective cohort study of patients diagnosed with benign phyllodes tumors by surgical excision between January 2000 and December 2022 at our institution. The medical and histopathological records were reviewed.Results:The results were obtained using the Cox proportional hazard regression and logistic regression. Resection margin status and recurrence were the independent variables. In each variable selection model, the resection margin was positive or less than 1 cm, and the recurrence rate was 3.7 and 1.04 times higher than the control group, but the difference was not statistically significant in 2 analyses.Conclusion:The surgical resection margin status of benign phyllodes tumors did not significantly affect locoregional recurrence. Therefore, follow-up imaging at short intervals without additional surgery is a feasible clinical option when the surgical resection margin is positive or less than 1 cm.

Purpose: This study aimed to determine the correlation between various clinical results, including recurrence in patients with breast cancer, and preoperative blood composition ratio and postoperative pathological results.Methods: A total of 444 patients who underwent surgery were included, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and postoperative pathological results were classified into postoperative cancer stages to confirm the association with various clinical results, including recurrence.Results: The median age of the patients was 51 years. The stages were divided into 1, 2, 3, and 4. Additionally, stages 1 and 2 comprised one group and stages 3 and 4 comprised another group. The cut-off values of the NLR, PLR, and MLR were confirmed to be 1.43, 158.84, and 0.21, respectively. It was noted that the association with recurrence was higher in the group with hormone receptor negative (p<0.001), higher stage (p<0.001), and underwent neoadjuvant chemotherapy (p<0.001). In the association with blood composition ratio and recurrence, survival was high in the PLR group with a high cut-off value (p=0.004). There was no significant relationship in the NLR and MLR groups. In the disease-free survival and overall-survival curves, only the PLR group showed a significant association of 0.003 and 0.001, respectively. The NLR and MLR groups did not show any significant result.Conclusion: No significant association with recurrence and mortality was confirmed in the NLR and MLR groups. However, the preoperative blood test in the high PLR group showed recurrence and mortality rate were high.

Appendiceal mucocele is a rare mucin-producing neoplasm of appendiceal origin. Due to its location and imaging findings, appendiceal mucocele is easily confused with tumors of the right adnexa. We present a rare case of a patient initially misdiagnosed with an ovarian tumor intraoperatively diagnosed as an appendiceal mucocele and successfully treated. A 66-year-old postmenopausal woman was admitted to the gynecology department for an asymptomatic pelvic mass. Preoperative pelvic imaging showed an 8-cm cystic mass. Exploratory laparoscopy for the suspected epithelial borderline tumor from the right ovary revealed a cystic mass in the right pelvic area and normal uterus, fallopian tubes, and ovaries. Intraoperative consultation with the general surgery department confirmed the appendiceal origin. Laparoscopic appendectomy was performed. Histopathological examination confirmed a low-grade mucinous neoplasm of appendiceal origin. The patient was discharged on a postoperative day 5 without complications. The outpatient follow-up performed 1 month later showed no evidence of disease progression. Despite the use of advanced diagnostic tools, appendiceal mucocele may be confused for ovarian malignancies. Because the clinical features of appendiceal mucocele are nonspecific, clinicians and radiologists know the specific imaging findings. A multidisciplinary approach including general surgery, gynecology, and radiology is required for preoperative diagnosis and treatment.

Purpose: As breast-conserving surgery has become a standard treatment for patients with breast cancer, several approaches have been devised to achieve desirable cosmetic results, including a method using a patient’s own tissues or organs or a mesh to resolve defects. However, its application has been limited due to the associated complications. Accordingly, breast reconstruction using an acellular dermal matrix (ADM) has been introduced to improve patients’ cosmetic satisfaction. However, the comparison of reconstruction and primary sutures using this method has not been well-studied. Therefore, this study surveyed patients who underwent breast cancer surgery based on cosmetic indicators to study the efficacy of ADM after breast-conserving surgery.Methods: This retrospective study included 68 patients diagnosed with breast cancer who underwent breast-conserving surgery at a single institution by a single surgeon from April 2019 to December 2020.Results: This study included 68 patients who underwent breast-conserving surgery. Among them, 22 patients underwent breast-conserving surgery using ADM, while 46 patients received only primary sutures without ADM. Among the items of the Breast Cancer Treatment Outcome Scale-12 (BCTOS-12), patient satisfaction was significantly higher in the group using ADM, than that in the control group in terms of breast shape (1.86±0.89 vs. 2.39±0.80, p=0.017). Regarding breast tenderness, the result also confirmed the group treated using ADM experienced less tenderness than the control group not treated with ADM (1.68±0.78 vs. 2.22±1.03, p=0.035). The two groups exhibited no significant differences in breast texture, arm heaviness, nipple appearance, shoulder discomfort, arm discomfort, scar tissue, arm swelling, breast swelling, fit of the bra, and breast sensitivity.Conclusion: Breast reconstruction using ADM in patients with breast cancer was effective from a cosmetic perspective. Prospective multicenter studies should be conducted to provide clear guidelines.

BACKGROUNDPapillary thyroid cancer (PTC) has good prognosis so that the local recurrence or distant metastasis can occur later on the lifetime follow up.In this study, we report recurrence of PTC in subcutaneous area combined with lymph node metastasis.A suspicion of needle tract implantation after core needle biopsy was found. CASE SUMMARYA 66-year-old female patients who underwent right thyroid lobectomy for PTC complained of palpable nodule on anterior neck area.The location of the palpable nodule was not associated with her postoperative scar.After excision of the skin tumor, it was diagnosed as recurrence of PTC.Furthermore, results of subsequent imaging showed lymph node metastasis on her right cervical area.According to the previous medical records, the patient received core needle biopsy through the neck of the patient midline and hematoma was noted after the procedure.The time interval from the first diagnosis to local recurrence or metastasis to the skin and lymph nodes was ten years.As treatment, the patient underwent lymph node dissection in the right and completion thyroidectomy for radioisotope treatment. CONCLUSIONNeedle tract implantation can occur after core needle biopsy.Further studies are needed to compare core-needle biopsy and fine-needle aspiration.

PURPOSE:Raloxifene is a selective estrogen receptor modulator (SERM), and raloxifene treatment for osteoporosis is reimbursable under the Korean National Health Insurance. Evidence suggests that SERMs use reduces the risk of breast cancer in Asian population. Herein, we retrospectively investigated the protective effect of raloxifene on breast cancer rates in Korean population.METHODS:Using the Health Insurance Review and Assessment Service database, we selected women with osteoporosis aged 50 years and above. Patients treated for at least 2 years with raloxifene were assigned to the user group, whereas the remaining patients were assigned to the non-user group. The effect on breast cancer risk was assessed using the Cox proportional-hazards model with a time-dependent covariate to adjust for immortal time bias.RESULTS:A total of 322,870 women who were registered between 2010 and 2011 were included. The user group comprised 0.7% (n = 2,307) of the total population. The mean age was 65.7 ± 8.0 years and 67.2 ± 8.6 years in the user and non-user groups, respectively (p < 0.001). There was no difference in the previous use of estrogen replacement between the 2 groups (p = 0.087). The incidence of breast cancer per 1,000 person-years was 0.49 (n = 8) and 0.68 (n = 1,714) in the user and non-user groups, respectively (hazard ratio [HR], 0.63, 95% confidence interval [CI], 0.32-1.27). HR decreased with increase in the treatment duration, but this change was not statistically significant (HR, 1.00, 95% CI, 0.32-3.11 in 2-3 years; HR, 0.63, 95% CI, 0.20-1.94 in 3-4 years; and HR, 0.41, 95% CI, 0.10-1.65 in 4-5 years).CONCLUSION:Long-term treatment with raloxifene in women with osteoporosis was not significantly associated with a reduction in breast cancer rates. However, further investigation is required for a conclusive proof.

We investigated whether textural parameters of peritumoral breast adipose tissue (AT) based on F-18 fluorodeoxyglucose (FDG) PET/CT could predict axillary lymph node metastasis in patients with breast cancer. A total of 326 breast cancer patients with preoperative FDG PET/CT were retrospectively enrolled. PET/CT images were visually assessed and the maximum FDG uptake of axillary lymph nodes (LN SUVmax) was measured. From peritumoral breast AT, 38 textural features of PET imaging were extracted. The diagnostic ability of PET based on visual analysis, LN SUVmax, and textural features of peritumoral breast AT for predicting axillary lymph node metastasis were assessed using the area under the receiver operating characteristic curve (AUC) values. Among the 38 peritumoral breast AT textural features, grey-level co-occurrence matrix (GLCM) entropy showed the highest AUC value (0.830) for predicting axillary lymph node metastasis. The value of GLCM entropy was higher than that of visual analysis (0.739; p < 0.05) and the AUC value was comparable to that of LN SUVmax (0.793; p > 0.05). In the subgroup analysis of patients with negative findings on visual analysis, GLCM entropy still showed a high diagnostic ability (AUC: 0.759) in predicting lymph node metastasis. The findings suggest a potential diagnostic role of PET/CT imaging features of peritumoral breast AT in predicting axillary lymph node metastasis in patients with breast cancer.

Background: Although international guidelines recommend bone screening for premenopausal breast cancer patients taking adjuvant tamoxifen, the effects of tamoxifen on osteoporosis and related risks remain controversial. The objective of this study was to investigate the incidence of and risk factors for osteoporosis and osteoporotic fractures in younger breast cancer patients. Methods: A nationwide retrospective cohort study was conducted using South Korea Health Insurance Review and Assessment Service claims data. The rates of osteoporosis and osteoporotic fracture were calculated as incident cases per person-year and disease-free probability rates were analyzed with the Kaplan-Meier method. To identify risk factors for osteoporosis and osteoporotic fracture, a multivariable Cox proportional hazard regression model was applied. Results: From January 2009 to December 2014, a total of 47,649 breast cancer patients were included. The incidence rates of osteoporosis and osteoporotic fracture were 23.59 and 2.40 per 1,000 person-years, respectively. In the overall population, tamoxifen was significantly associated with a decreased risk of osteoporosis and osteoporotic fractures 0.76). However, tamoxifen was not associated with the risk of osteoporosis (HR 1.24, CI 0.85-1.82) and osteoporotic fracture (HR 8.15, CI 0.36-186.70) in patients under age 40. In the 40-49 years subgroup, tamoxifen significantly decreased the risk of osteoporosis (HR 0.74, CI 0.65-0.84) and osteoporotic fracture (HR 0.49, CI 0.31-0.76). Conclusions: Tamoxifen is not associated with an increased risk of osteoporosis and osteoporotic fracture in premenopausal breast cancer patients. Tailored screening strategies for breast cancer survivors with different osteoporosis risks are needed. Precis: Tamoxifen is not associated with an increased risk of osteoporosis and osteoporotic fracture in premenopausal breast cancer patients. Tailored screening strategies for breast cancer survivors who are at different risks of developing osteoporosis are needed.

Background The objective of this study was to investigate the prognostic value of 2-Deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG) uptake of bone marrow (BM) and metabolic parameters of primary tumor on positron emission tomography/computed tomography (PET/CT) for predicting distant recurrence in patients with breast cancer. Methods Pretreatment [ 18 F]FDG PET/CT images of 345 breast cancer patients were retrospectively evaluated. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of primary breast cancer and bone marrow-to-liver uptake ratio (BLR) on PET/CT were measured. A Cox proportional hazard regression model was used to evaluate the prognostic potential of parameters for predicting recurrence-free survival (RFS) and distant RFS. For Kaplan-Meier analysis, the specific cutoff values pf BLR and TLG were determined by the maximal chi-square method. Results The median follow-up duration of the enrolled patients was 48.7 months, and during follow-up, 36 patients (10.4%) experienced the cancer recurrence. BLR was significantly correlated with T stage, serum inflammatory markers, and recurrence pattern ( p < 0.05). Patients with high BLR and TLG showed worse RFS and distant RFS than those with low BLR and TLG. On multivariate analysis, BLR was significantly associated with both RFS and distant RFS after adjusting for T stage, estrogen receptor status, and TLG ( p = 0.001 for both). Only 0.5% of patients with TLG < 9.64 g and BLR < 0.91 experienced distant recurrence. However, patients with TLG ≥ 9.64 g and BLR ≥ 0.91 had a distant recurrence rate of 40.7%. Conclusions BLR on pretreatment [ 18 F]FDG PET/CT were significant predictors for RFS and distant RFS in patients with breast cancer. By combining [ 18 F]FDG uptake of BM and volumetric PET/CT index of breast cancer, the risk of distant recurrence could be stratified.

Purpose:High incidence of osteoporosis has been reported in breast cancer patients due to early menopause triggered by adjuvant treatment and temporary ovarian function suppression. In this study, we sought to determine whether long-term breast cancer survivors had an elevated risk of low bone density compared to the general population.Methods:Long-term breast cancer survivors who had been treated for more than 5 years were selected for this study. Data were obtained from medical records and using a questionnaire from the Korea National Health and Nutrition Examination Survey (KNHANES). An age-matched non-cancer control group was selected from the KNHANES records. Incidence of fracture and bone mineral density (BMD) were compared between the two groups.Results:In total, 74 long-term breast cancer survivors and 296 non-cancer controls were evaluated. The incidence of fracture did not differ between the two groups (P=0.130). No differences were detected in lumbar BMD (P=0.051) following adjustment for body mass index, while hip BMD was significantly lower in breast cancer survivors (P=0.028). Chemotherapy and endocrine treatment were not related to low BMD in breast cancer survivors. In more than half of the survivors, the 10-year risk of osteoporotic fracture was less than 1%.Conclusion:Long-term breast cancer survivors had low bone density but a comparable risk of fracture compared to non-cancer age-matched controls. Further studies on the factors related to low bone density in long-term breast cancer survivors are required.

Purpose: Breast cancer is the most common cancer in Korean women and the number of cases is increasing. We have found various histopathological differences in breast cancer and are using this knowledge for treatment. Various factors may help determine the progression of cancer in patients. The expression of lymphovascular invasion, a pathologic factor, denotes a poor prognosis. We analyzed the characteristics of patients showing lymphatic invasion. Methods: Data from 606 patients with breast cancer who underwent surgery between 2006 and 2016 were collected. We analyzed various pathologic factors in patients with or without lymphatic invasion expression. Results: Mean age was 52.0±11.2 years (range 29-83 years) and mean follow-up duration was 57.3 months (range 3−125 months). Pathologically, breast cancer types were invasive ductal carcinoma (552, 91.2%), invasive lobular carcinoma (21, 3.4%), and other pathologies (33, 5.4%). Number of patients in stages I, II, III, and IV were 299 (49.3%), 223 (36.8%), 82 (13.7%), and 2 (0.02%), respectively. Immunohistochemistry revealed 396 (65.3%) estrogen receptor (ER)-positive cases, 287 (47.3%) progesterone receptor (PR)-positive cases, and 139 (22.9%) human epidermal growth factor receptor 2 (HER2)-positive cases. Seven patients had local recurrence and 41 patients had distant metastasis, which included 14 bone, 7 lung, 5 liver, and 15 multiple metastases. Seventeen patients showed lymphatic invasion, while 24 patients were without lymphatic invasion. Significant association was observed between T and N stages and lymphatic invasion (p<0.001). No significant correlation was observed between lymphatic invasion and ER (p=0.073), HER2 (p=0.553). However, there was a significant correlation between lymphatic invasion and PR (p=0.044). Overall survival and disease free survival rates were significantly worse in the presence of lymphatic invasion (p<0.01, 0.011, respectively). Conclusion: Lymphatic invasion was associated with T and N stages, overall survival and disease free survival. More careful observation and treatment strategy is needed, especially in locally advanced breast cancer.

Background The present study aimed to investigate whether dual-phase F-18 sodium-fluoride (NaF) positron emission tomography/computed tomography (PET/CT) could improve the diagnostic accuracy of detecting bone metastasis in cancer patients with a solitary bone lesion compared to conventional F-18 NaF PET/CT. Methods We retrospectively enrolled 113 cancer patients who underwent dual-phase F-18 NaF PET/CT for the differential diagnosis of a solitary bone lesion seen on bone scintigraphy. According to the dual-phase PET/CT protocol, an early-phase scan was acquired immediately after radiotracer injection and a conventional F-18 NaF PET/CT scan was performed. The diagnostic abilities of the visual analysis of conventional and dual-phase PET/CT scans and two quantitative parameters (lesion-to-blood pool uptake ratio on early-phase scan and lesion-to-bone uptake ratio on conventional scan) for detecting bone metastasis were compared. The final diagnosis of bone metastasis was made by histopathological confirmation or follow-up imaging studies. Results A metastatic bone lesion was diagnosed in 28 patients (24.8%). The sensitivity, specificity, and accuracy were 100.0%, 70.6%, and 77.9%, respectively, for visual analysis of conventional F-18 NaF PET/CT, 92.9%, 42.4%, 54.9%, respectively, for lesion-to-bone uptake ratio, 96.4%, 88.2%, and 90.3%, respectively, for visual analysis of dual-phase PET/CT, and 92.9%, 81.2%, and 83.2%, respectively, for lesion-to-blood pool uptake ratio. Visual analysis of dual-phase PET/CT was shown to have the highest area under the receiver operating characteristic curve value (0.923; 95% CI, 0.858-0.965) among all parameters. Conclusions Dual-phase F-18 NaF PET/CT showed a high diagnostic ability for detecting bone metastasis with improved specificity and accuracy compared to conventional F-18 NaF PET/CT in cancer patients. Dual-phase F-18 NaF PET/CT might help diagnose bone metastasis in patients with malignancies who were shown to have a solitary bone lesion on bone scintigraphy.

The purpose of this study was to evaluate the prognostic significance of computed tomography (CT)-attenuation of tumor-adjacent breast adipose tissue for predicting recurrence-free survival (RFS) in patients with breast cancer. We retrospectively enrolled 287 breast cancer patients who underwent pretreatment 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. From non-contrast-enhanced CT images of PET/CT, CT-attenuation values of tumor-adjacent breast adipose tissue (TAT HU) and contralateral breast adipose tissue (CAT HU) were measured. Difference (HU difference) and percent difference (HU difference %) in CT-attenuation values between TAT HU and CAT HU were calculated. The relationships of these breast adipose tissue parameters with tumor factors and RFS were assessed. TAT HU was significantly higher than CAT HU (p < 0.001). TAT HU, HU difference, and HU difference % showed significant correlations with T stage and estrogen receptor and progesterone receptor status (p < 0.05), whereas CAT HU had no significant relationships with tumor factors (p > 0.05). Patients with high TAT HU, HU difference, and HU difference % had significantly worse RFS than those with low values (p < 0.001). In multivariate analysis, TAT HU and HU difference % were significantly associated with RFS after adjusting for clinico-pathologic factors (p < 0.05). CT-attenuation of tumor-adjacent breast adipose tissue was significantly associated with RFS in patients with breast cancer. The findings seem to support the close contact between breast cancer cells and tumor-adjacent adipocytes observed with imaging studies.