Although fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood. Therefore, this study aims to investigate the relation between the fatigue ...and mindfulness of breast cancer survivors using anxiety, depression, pain, loneliness, and sleep disturbance as mediators.
Path analysis was performed to examine direct and indirect associations between mindfulness and fatigue. Participants were breast cancer survivors who visited a breast surgery department at a university hospital in Japan for hormonal therapy or regular check-ups after treatment. The questionnaire measured cancer-related-fatigue, mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance. Demographic and clinical characteristics were collected from medical records.
Two-hundred and seventy-nine breast cancer survivors were registered, of which 259 answered the questionnaire. Ten respondents with incomplete questionnaire data were excluded, resulting in 249 participants for the analyses. Our final model fit the data well (goodness of fit index = .993; adjusted goodness of fit index = .966; comparative fit index = .999; root mean square error of approximation = .016). Mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance were related to fatigue, and mindfulness had the most influence on fatigue (β = - .52). Mindfulness affected fatigue not only directly but also indirectly through anxiety, depression, pain, loneliness, and sleep disturbance.
The study model helps to explain the process by which mindfulness affects fatigue. Our results suggest that mindfulness has both direct and indirect effects on the fatigue of breast cancer survivors and that mindfulness can be used to more effectively reduce their fatigue. It also suggests that health care professionals should be aware of factors such as anxiety, depression, pain, loneliness, and sleep disturbance in their care for fatigue of breast cancer survivors.
This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN number. 000027720) on June 12, 2017.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Predicting pathogenic germline variants (PGVs) in breast cancer patients is important for selecting optimal therapeutics and implementing risk reduction strategies. However, PGV risk factors and the ...performance of prediction methods in the Japanese population remain unclear. We investigated clinicopathological risk factors using the Tyrer‐Cuzick (TC) breast cancer risk evaluation tool to predict BRCA PGVs in unselected Japanese breast cancer patients (n = 1,995). Eleven breast cancer susceptibility genes were analyzed using target‐capture sequencing in a previous study; the PGV prevalence in BRCA1, BRCA2, and PALB2 was 0.75%, 3.1%, and 0.45%, respectively. Significant associations were found between the presence of BRCA PGVs and early disease onset, number of familial cancer cases (up to third‐degree relatives), triple‐negative breast cancer patients under the age of 60, and ovarian cancer history (all P < .0001). In total, 816 patients (40.9%) satisfied the National Comprehensive Cancer Network (NCCN) guidelines for recommending multigene testing. The sensitivity and specificity of the NCCN criteria for discriminating PGV carriers from noncarriers were 71.3% and 60.7%, respectively. The TC model showed good discrimination for predicting BRCA PGVs (area under the curve, 0.75; 95% confidence interval, 0.69‐0.81). Furthermore, use of the TC model with an optimized cutoff of TC score ≥0.16% in addition to the NCCN guidelines improved the predictive efficiency for high‐risk groups (sensitivity, 77.2%; specificity, 54.8%; about 11 genes). Given the influence of ethnic differences on prediction, we consider that further studies are warranted to elucidate the role of environmental and genetic factors for realizing precise prediction.
Combination of major clinicopathological risk factors and predictive scores could help identify and characterize high‐risk population carrying BRCA1/2 PGVs among Japanese breast cancer patients. Significant associations were found between the presence of PGVs and early disease onset, number of familial cancer cases within third‐degree relatives, triple‐negative breast cancer patients under the age of 60, and ovarian cancer history (all P < .0001).
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
In order to determine the patients who require biopsy for breast clustered microcysts, we retrospectively investigated cases of clustered microcysts that were detected by ultrasonography ...(US) examinations.
Methods
We investigated 52 patients in whom clustered microcysts were detected by US and who underwent biopsy at our institution between January 2011 and March 2014. These patients were divided into two groups according to histopathological findings: those with invasive carcinoma (IC), ductal carcinoma in situ (DCIS), or mucocele-like tumor (MLT) (Group 1), and those with benign lesions (Group 2). Mammography (MG) and magnetic resonance imaging (MRI) findings were assessed in these two groups.
Results
There were 12 patients in Group 1 (IC:2, DCIS:6, and MLT:4) and 40 patients in Group 2. In 51 of the 52 patients, MG was performed before biopsy. Since 11 of 12 patients in Group 1 exhibited MG findings (mass, focal asymmetry, coarse heterogeneous calcifications and fine pleomorphic calcifications) at the same site as the clustered microcysts, and that MG findings had a significant probability of detecting clustered microcysts categorized into Group 1 with a sensitivity of 91.7 % and negative predictive value (NPV) of 96.8 % (
p
< 0.001). In contrast, MRI was performed in 39 of the 52 patients, and only 3 of the 9 Group 1 patients (33.3 %) for whom MRI was performed were detected as MRI Category 4 or 5 enhancement.
Conclusion
The patients who exhibit clustered microcysts with MG findings (mass, focal asymmetry, coarse heterogeneous calcifications and fine pleomorphic calcifications) appear to require biopsy.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose: We assessed the influence of the menstrual cycle on background parenchymal enhancement (BPE) of the breast in the early and delayed phases of dynamic magnetic resonance (MR) imaging and the ...optimal timing of MR imaging of the breast in Japanese women. Material and Methods: We reviewed dynamic MR images of 165 consecutive women with regular menstrual cycles and divided the women into 4 groups by week of the menstrual cycle: 32 in Week One (Days 1 through 4 of the menstrual cycle); 46 in Week 2 (Days 5 through 12); 49 in Week 3 (Days 13 through 20); and 38 in Week 4 (Days 21 through 30). We qualitatively evaluated BPE of the whole breast in the early and delayed phases of MR imaging; categorized enhancement as minimal, mild, moderate, or marked; and calculated the rate at which signal intensity increased (=SI post−SI pre/SI pre) in regions of interest in from the early and delayed phase to the before contrast administration phase to assess BPE quantitatively. Results: In both the early and delayed dynamic MR phases, BPE was significantly more extensive and stronger in Week 4 than Week 2 (P<0.01). Throughout the menstrual cycle, BPE was significantly stronger in the delayed phase than in the early phase in both qualitative (Week One, P=0.0002; Weeks 2 through 4, P<0.0001) and quantitative (Weeks One through 4, P<0.0001) assessments. Conclusion: The optimal time to perform dynamic breast MR imaging in premenopausal Japanese women was during Days 5 through 12 of the menstrual cycle.
Objectives
To evaluate whether magnetic resonance (MR) imaging features can predict the presence of occult invasion in cases of biopsy-proven pure ductal carcinoma in situ (DCIS).
Methods
We ...retrospectively reviewed 92 biopsy-proven pure DCIS in 92 women who underwent MR imaging. The following MR imaging findings were compared between confirmed DCIS and invasive breast cancer (IBC): lesion size, type, morphological and kinetic assessments by ACR BI-RADS MRI, and findings of fat-suppressed T2-weighted (FS-T2W) imaging.
Results
Sixty-eight of 92 (74%) were non-mass-like enhancements (NMLE) and 24 were mass lesions on MR imaging. Twenty-one of 68 (31%) NMLE and 13 of 24 (54%) mass lesions were confirmed as IBC. In NMLE lesions, large lesions (
P
= 0.007) and higher signal intensities (SI) on FS-T2W images (
P
= 0.032) were significantly associated with IBC. Lesion size remained a significant independent predictor of invasion in multivariate analysis (
P
= 0.032), and combined with FS-T2W SIs showed slightly higher observer performances (area under the curve, AUC, 0.71) than lesion size alone (AUC 0.68). There were no useful findings that enabled the differentiation of mass-type lesions.
Conclusions
Breast MR imaging is potentially useful to predict the presence of occult invasion in biopsy-proven DCIS with NMLE.
Key Points
MR mammography permits more precise lesion assessment including ductal carcinoma in situ
A correct diagnosis of occult invasion before treatment is important for clinicians
This study showed the potential of MR mammography to diagnose occult invasion
Treatment and/or aggressive biopsy can be given with greater confidence
MR mammography can lead to more appropriate management of patients
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Purpose
This study compared the clinical utility of indocyanine green (ICG) fluorescence and radioisotope (RI) for sentinel lymph node (SLN) detection in breast cancer.
Methods
Women with ...node-negative breast cancer underwent SLN biopsy using ICG fluorescence and RI. The primary end point was the sensitivity of ICG fluorescence compared with RI in the patients with tumor-positive SLNs. Secondary end points included detection rates for SLN, the additive effect of ICG fluorescence to RI, signature of positive SLNs according to tier, and adverse events related to ICG administration.
Results
A total of 847 women with clinical node-negative breast cancer underwent SLN biopsy, and 821 patients were included in the per-protocol analysis. SLN mapping was performed using ICG fluorescence and RI. The overall detection of SLNs using ICG fluorescence was identical to RI (97.2 vs. 97.0 %,
P
= 0.88), and the combination of both methods achieved a significant improvement compared with RI alone (99.8 vs. 97.0 %,
P
< 0.001). The detection rate for tumor-positive SLN was 93.3 % for ICG fluorescence and 90.0 % for RI, and the sensitivity of the ICG fluorescence method was 95.7 % (95 % CI 91.3–98.3,
P
= 0.11). The additional use of ICG significantly improved positive SLN detection for RI (97.2 vs. 90.0 %,
P
< 0.001). There were no serious adverse events related to hypersensitivity to ICG.
Conclusions
The ICG fluorescence method may be an acceptable alternative to SLN detection using RI in breast cancer.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
A 61-year-old man was found to have anemia 3 years after an aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) of the left intrathoracic artery to the left anterior descending ...artery and the right gastroepiploic artery (RGEA) to the right coronary artery (RCA) for aortic insufficiency and angina pectoris. A IIc gastric cancer in the antrum was subsequently diagnosed. Computed tomography (CT) and coronary angiography showed lymph node metastasis at the root of the RGEA, which perfused a large area of the inferoposterior wall of the heart. To prevent cardiac ischemia and perform complete #6 lymph node dissection, percutaneous intervention was carried out on the RCA before distal gastrectomy with D2 lymph node dissection, and the RGEA was reconstructed as a free graft to the left gastric artery. This procedure may be a surgical option for gastric cancer in patients who have undergone CABG using the RGEA.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract
Background: Breast cancer risk models are used to predict the risk of carrying a variant, for one of the most common breast cancer susceptibility genes such as BRCA1 and BRCA2, and the ...lifetime risk of developing breast cancer. The prediction of harboring a germline variant of the BRCA gene and the development of breast or ovarian cancer over time affects the decision-making for undergoing genetic testing and screening using imaging techniques as the common practice. For instance, the American Cancer Society and the National Comprehensive Cancer Network (NCCN) recommends screening using MRI in women with 20% or greater lifetime risk of having breast cancer. We aimed to investigate the prediction of these risks in Japanese women, particularly on the relationship between the presence of pathogenic germline variants and breast cancer susceptibility genes, using a cohort of 1016 primary breast cancer patients.
Patients and Methods: We analyzed a cohort of Japanese patients with primary breast cancer who were treated at the Kyoto University Hospital and the related institutions or hospitals from the period of 2011 to 2016. The germline variants were examined for a set of 13 breast cancer susceptibility genes, using targeted-capture sequencing of pooled DNA, and it was found that 66 out of 1016 patients had pathogenic variants. These included 11 functionally well-established genes (BRCA1, BRCA2, TP53, PTEN, CDH1, STK11, NF1, PALB2, ATM, CHEK2, and NBN) and two additional genes (BARD1 and BRIP1), which are recommended for the screening of high-risk patients with hereditary breast cancer in the NCCN guidelines. Using this cohort, we studied the association of the calculated risk of carrying a germline variant of BRCA1/ BRCA2, using the Tyrer-Cuzick model Breast Cancer Risk Evaluation Tool, within the laboratory germline test results.
Results: Pathogenic germline variants of BRCA1/ BRCA2 were carried by 54 (5.3%) out of the 1016 patients (12 cases of BRCA1 and 42 cases of BRCA2). According to the NCCN guidelines, which focus on Genetic/ Familial High-Risk Assessment: Breast and Ovarian, it was found that 500 out of 1016 (49.2%)patients were categorized for considering germline testing. In fact, 38 (7.6%) of the 500 patients, harbored a pathogenic germline variant of BRCA1/ BRCA2. In the remaining 516 patients, 16 (3.1%) harbored the pathogenic germline variant of BRCA1/ BRCA2. The predictive risks of the Tyrer-Cuzick model Breast Cancer Risk Evaluation Tool were recorded as follows: Area under the ROC curve, BRCA1 (area 0.750, 95% CI- 0.581-0.919), BRCA2 (area 0.741, 95% CI- 0.661-0.820), BRCA1 or BRCA2 (Area 0.749, 95% CI: 0.675-0.822), suggesting that the Tyrer-Cuzick model may be useful for the Japanese population. In the mammography breast density analysis, 484 patients showed almost entirely fat or scattered fibroglandular breast tissue, and 362 cases had heterogeneous or extreme fibroglandular breast tissue. In this study, the correlations of breast tissue density with age and breast or ovarian cancer familial history have been reported in greater detail.
Discussion and Conclusions: In a retrospective cohort of 1016 Japanese patients with primary breast cancer, 5.3% had pathogenic germline variants of BRCA1/ BRCA2. In a group recommended by NCCN guidelines for considering genetic testing, the BRCA1/ BRCA2 variant rate was 7.6%. Predictive risks calculated by the Tyrer-Cuzick model similar with the known data. Further data are reported.
Citation Format: Noriko Senda, Nobuko Kawaguchi-Sakita, Masahiro Kawashima, Yukiko Inagaki-Kawata, Kenichi Yoshida, Tomomi Nishimura, Masahiro Takada, Eiji Suzuki, Yuki Kataoka, Fumiaki Sato, Yoshiaki Matsumoto, Masae Torii, Hiroshi Yoshibayashi, Kazuhiro Yamagami, Shigeru Tsuyuki, Akira Yamauchi, Nobuhiko Shinkura, Hironori Kato, Yoshio Moriguchi, Ryuji Okamura, Norimichi Kan, Hirofumi Suwa, Shingo Sakata, Susumu Mashima, Fumiaki Yotsumoto, Tsuyoshi Tachibana, Mitsuru Tanaka, Takashi Inamoto, Masahiro Sugimoto, Seishi Ogawa, Masakazu Toi. Relationship between predicted risks of carrying breast cancer susceptibility genes and the presence of germline variants in Japanese patients with primary breast cancer abstract. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-12.
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