Abstract P4-02-13: Breast ultrasound surveillance with image fusion technique in a short-interval follow-up for BI-RADS category 3 mass lesions

PURPOSE: Breast ultrasound (US) is a diagnostic imaging modality that is now widely used as an adjunct to mammography for evaluation of breast abnormalities. In the Breast Imaging-Reporting and Data System (BI-RADS) lexicon, a solid mass with an oval shape, well-circumscribed margins and parallel orientation is classified as category 3 (BI-RADS category 3 mass lesions) . This mass should have a risk of malignancy of < 2%. Surveillance breast US in short-interval follow-up for BI-RADS category 3 mass lesions is an acceptable alternative to biopsy. The surveillance US is recommended 6 month after initial lesion identification and then every year for at least 2 y. However, inconsistent reproducibility for US due to operator dependence is still a clinical issue. The aim of our study was to verify the utility of US using real-time virtual sonography (RVS) - to coordinate present US images with past US images reconstructed from previously acquired US volume data using magnetic tracking system – in a short-interval follow--up for BI-RADS category 3 mass lesions.

METHOD AND MATERIALS: We enrolled 20 women (23 lesions) with more than 24 months of follow-up after classification as BI-RADS category 3 during initial US. US surveillance was scheduled at 6, 12 and 24 months. Three-dimensional assessment of morphologic features was performed while serially checking past US volume data corresponding to the present US probe position. Measurement of the target lesion diameter was performed after the probe was adjusted to include the maximum diameter of a past US image at each visit.

RESULTS: RVS was technically successful in 100% of patients. All target lesions were detected, including two iso-echoic lesions. The mean target lesion diameters at baseline and at 6, 12 and 24 months were 8.2+4.2, 8.4+4.5, 8.1+4.5 and 8.3+5.0 mm, respectively . Statistical analysis using a Friedman test with multiple comparisons revealed no significant difference between the diameters at each time point (p = 0.785). RVS was used to directly compare the US morphologic characteristics and sized of lesions. Furthermore, the RVS data can be reproduced in their entirety for independent review at a later date by using stored US volume data.

CONCLUSION:Our results suggest that RVS is reproducible, operator-independent technique for comparison of US images of BI-RADS category 3 mass lesions obtained at different time points.

Citation Format: Nakano S, Fujii K, Kousaka J, Mouri Y, Ando T. Breast ultrasound surveillance with image fusion technique in a short-interval follow-up for BI-RADS category 3 mass lesions [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-02-13.

A glial K(+) /Cl(-) cotransporter modifies temperature-evoked dynamics in Caenorhabditis elegans sensory neurons

K(+) /Cl(-) cotransporters (KCCs) are known to be crucial in the control of neuronal electrochemical Cl(-) gradient. However, the role of these proteins in glial cells remains largely unexplored despite a number of studies showing expression of KCC proteins in glial cells of many species. Here, we show that the Caenorhabditis elegans K(+) /Cl(-) cotransporter KCC-3 is expressed in glial-like cells and regulates the thermosensory behavior through modifying temperature-evoked activity of a thermosensory neuron. Mutations in the kcc-3 gene were isolated from a genetic screen for mutants defective in thermotaxis. KCC-3 is expressed and functions in the amphid sheath glia that ensheathes the AFD neuron, a major thermosensory neuron known to be required for thermotaxis. A genetic analysis indicated that the regulation of the thermosensory behavior by KCC-3 is mediated through AFD, and we further show that KCC-3 in the amphid sheath glia regulates the dynamics of the AFD activity. Our results show a novel mechanism by which the glial KCC-3 protein non-cell autonomously modifies the stimulus-evoked activity of a sensory neuron and highlights the functional importance of glial KCC proteins in modulating the dynamics of a neural circuitry to control an animal behavior.

Antibody against chromatin assembly factor-1 is a novel autoantibody specifically recognized in systemic lupus erythematosus

Autoantibodies to proliferating cell nuclear antigen (PCNA) are specifically, if rarely, present in systemic lupus erythematosus (SLE) patient sera. Even SLE patients lacking PCNA reactivity often show reaction to PCNA-binding protein. Here, immunoreactivity to chromatin assembly factor-1 (CAF-1), an essential molecule for DNA replication and a PCNA-binding protein, was compared for the sera of SLE patients, normal healthy controls (NHCs) and other disease controls, and in autoimmune sera reactive to standard autoantigens, by enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence, and immunoblotting. CAF1 and IRF1 expression in SLE and NHC peripheral mononuclear cells were compared by quantitative real-time polymerase chain reaction. Serum interferon-γ-inducing protein-10 and anti-double-stranded (ds)DNA antibody levels were measured by ELISA. Increased CAF-1 autoimmune reactivity was recognized in SLE or serum anti-dsDNA antibody-positive patients. Significantly greater central nervous system (CNS) involvement (aseptic meningitis) and serum anti-dsDNA antibody titers were present more often in anti-CAF-1 antibody-positive than antibody-negative SLE patients. IFN-γ positively regulated CAF-1 expression in vitro and was associated with anti-CAF-1 antibody production in SLE. Thus, a novel anti-CAF-1 autoantibody is frequently found in patients with SLE and is a useful biomarker for diagnosis, especially in cases with CNS involvement. Aberrant IFN-γ regulation appears to play an important role in anti-CAF-1 antibody production in SLE.

Discontinuation of leisure time impact-loading exercise is related to reduction of a calcaneus quantitative ultrasound parameter in young adult Japanese females: a 3-year follow-up study

A 3-year follow-up study on 334 young Japanese females enrolled in a university at the age of 18 years revealed that discontinuation of leisure time impact-loading exercises performed in junior high and/or high school was associated with increased risk of reduction in calcaneus osteo-sono assessment index (OSI).

INTRODUCTION

Bone strength rapidly increases during puberty and reaches its peak by the end of adolescence. The aim of this study was to determine the lifestyle factors that influence the maintenance of calcaneus OSI in young adult females around the time when peak bone mass is attained.

METHODS

Annual health checkups including OSI measurements, anthropometrics, lifestyle analysis, and blood examination were performed 4 times on 334 Japanese females enrolled in a university at the age of 18 years. According to the slope of OSI change during the 3-year follow-up, the subjects were grouped into two categories: OSI loss (the lowest tertile) and OSI gain/stable (the second and third tertiles).

RESULTS

At the baseline assessment, the OSI loss group had higher OSI and height and an earlier menarche age than the OSI gain/stable group. Performing leisure time impact-loading exercise in junior high and/or high school but discontinuing it at university was associated with increased risk of OSI loss, independent of OSI, height and weight at the age of 18 years, weight change during follow-up, age of menarche, energy-adjusted nutrient intake, and alcohol drinking; the odds ratios were 4.1-4.9 compared with those performing impact-loading exercise at university. In particular, duration, frequency, and subjective intensity of impact-loading exercise during high school were positively associated with OSI loss.

CONCLUSION

Discontinuation of leisure time impact-loading exercises performed during late adolescence is associated with an increased risk of OSI loss in young adult females during the 3-year follow-up period.

Stereotactic Body Radiotherapy: Volumetric Modulated Arc Therapy versus 3D Non-Coplanar Conformal Radiotherapy for the Treatment of Early Stage Lung Cancer

Stereotactic body radiotherapy (SBRT) is a treatment option for patients with early stage lung cancer. Treatment duration can be >30 minutes per fraction with non-coplanar 3D-conformal radiotherapy (3D-CRT). Whilst this is generally well tolerated, faster delivery techniques are desirable. Volumetric modulated arc therapy (VMAT) allows for fast delivery of radiation treatment. The purpose of this planning study was to compare SBRT with 3D-CRT and VMAT, with VMAT plans generated using both single arc and 3 non-coplanar partial arcs. Ten patients who previously underwent SBRT (48 Gy in 4 fractions) with 3D-CRT were selected. VMAT plans were generated to treat the PTV while limiting doses to organs at risk. Cumulative dose volume histogram (DVH) parameters were compared between the 3 techniques using the Wilcoxon matched pairs test. Treatment delivery time was also assessed. Both VMAT techniques covered target volumes more conformally than 3D-CRT with a mean V48/VPTV of 1.21 for 3D-CRT, 1.03 for 3 arc plans and 1.01 for single arc plans (ρ = 0.005). Dose constraints to organs at risk were met using all three techniques. Mean lung doses were 2.93 Gy for 3D-CRT, 2.87 Gy for single arc and 2.73 Gy for the 3 arc technique (3-arc vs. 3D-CRT: ρ = 0.009). Lung V20 for 3D-CRT, 1 arc and 3 arcs were 3.24%, 2.89% and 2.73%, respectively (3-arc vs. 3D-CRT: ρ = 0.028). Mean time to deliver a single fraction was 13 minutes for 3D-CRT, 9.2 minutes for 3 arcs and 5.5 minutes for 1 arc. VMAT resulted in improved conformality compared to 3D-CRT. The 3 arc technique appears to have the lowest dose to lung although the magnitude is unlikely to be clinically significant. The main advantage of VMAT over 3D-CRT is faster treatment delivery time. Shortened treatment times are anticipated to improve tolerability of this treatment and reduce the chance of error due to intra-fraction motion.

Levodopa challenge test and (123) I-metaiodobenzylguanidine scintigraphy for diagnosing Parkinson's disease

OBJECTIVES

To explore the possibility of a generally applicable tool for the immediate diagnosis of Parkinson's disease (PD) in its early stage, we compared the sensitivity and specificity of an acute levodopa challenge test with that of (123) I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy.

MATERIALS AND METHODS

A consecutive series of 45 patients with extrapyramidal symptoms were recruited to the acute levodopa challenge and evaluated for improvement by use of the Unified Parkinson's Disease Rating Scale motor scores. Of these patients, 32 of them were also examined by MIBG scintigraphy. The patients were followed up for at least 24 months, and 22 patients were diagnosed as having clinically definite PD.

RESULTS

The sensitivity and specificity of the acute levodopa challenge test to predict clinical diagnosis of PD were 81.8% and 81.8%, respectively, which were better than those obtained by MIBG scintigraphy (62.5% and 62.5%). In both early- and middle-stages of PD, the test gave better sensitivity than MIBG scintigraphy.

CONCLUSIONS

Considering that the well-established and frequently referred clinical diagnostic criteria require longitudinal observation for at least 24 months, the acute levodopa challenge test can be used as an immediate diagnostic tool for PD with sensitivity and specificity comparable to those of MIBG.

Abstract P4-03-08: A new real-time image fusion technique, a coordinated sonography and MRI using magnetic position tracking system, improves the sonographic identification of enhancing lesions in breast MRI

Breast magnetic resonance imaging (MRI) is a method that can detect clinically and mammographically occult cancer foci. For lesions suspected to be malignant on the basis of breast MRI, targeted sonography can help determine whether the lesion is amenable to tissue biopsy using sonographic guidance. However, the reproducibility of sonography as well as interexaminer reliability in targeted sonography is still a clinical issue. Recently, we have developed real-time virtual sonography (RVS) that can coordinate a sonographic image and a MRI multiplanar reconstruction (MRI-MPR) of the same section in real time. Although RVS has been reported to be useful for breast cancers, only a few studies have investigated the size and positioning error between a real-time sonographic image and a MRI-MPR image. The purpose of this study was to evaluate the accuracy of RVS to sonographically identify enhancing lesions by breast MRI. Between December 2008 and May 2009, RVS was performed in 51 consecutive patients with 63 enhancing lesions. MRI was performed with the patients in the supine position using a 1.5-T imager with a body surface coil to achieve the same position as with sonography. To assess the accuracy of the RVS, the following three issues were analyzed: (i) The sonographic detection rate of enhancing lesions, (ii) the comparison of the tumor size measured by sonography and the MRI-MPR and (iii) the positioning errors as the distance from the actual sonographic position to the expected MRI position in 3-D. Among the 63 enhancing lesions, 42 (67%) lesions were identified by conventional B-mode, whereas the remaining 21 (33%) initial conventional B-mode occult lesions were identified by RVS alone. The sonographic size of the lesions detected by RVS alone was significantly smaller than that of lesions detected by conventional B-mode (p < 0.001). The mean tumor size provided by RVS was 12.3 mm for real-time sonography and 14.1 mm for MRI-MPR (r = 0.848, p < 0.001). The mean positioning errors for the transverse and sagittal planes and the depth from the skin were 7.7, 6.9 and 2.8 mm, respectively. The overall mean 3D positioning error was 12.0 mm. Our results suggest that RVS has good targeting accuracy to directly compare a sonographic image with MRI results without operator dependence.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-08.

The combined effect of the T2DM susceptibility genes is an important risk factor for T2DM in non-obese Japanese: a population based case-control study

Background

Type 2 diabetes mellitus (T2DM) is a complex endocrine and metabolic disorder. Recently, several genome-wide association studies (GWAS) have identified many novel susceptibility loci for T2DM, and indicated that there are common genetic causes contributing to the susceptibility to T2DM in multiple populations worldwide. In addition, clinical and epidemiological studies have indicated that obesity is a major risk factor for T2DM. However, the prevalence of obesity varies among the various ethnic groups. We aimed to determine the combined effects of these susceptibility loci and obesity/overweight for development of T2DM in the Japanese.

Methods

Single nucleotide polymorphisms (SNPs) in or near 17 susceptibility loci for T2DM, identified through GWAS in Caucasian and Asian populations, were genotyped in 333 cases with T2DM and 417 control subjects.

Results

We confirmed that the cumulative number of risk alleles based on 17 susceptibility loci for T2DM was an important risk factor in the development of T2DM in Japanese population (P < 0.0001), although the effect of each risk allele was relatively small. In addition, the significant association between an increased number of risk alleles and an increased risk of T2DM was observed in the non-obese group (P < 0.0001 for trend), but not in the obese/overweight group (P = 0.88 for trend).

Conclusions

Our findings indicate that there is an etiological heterogeneity of T2DM between obese/overweight and non-obese subjects.

P2-10-10: A Precision Comparison of Breast Ultrasound Images between Different Time Phases by Imaging Fusion Technique Using Magnetic Position Tracking System

Purpose: We developed a real-time virtual sonography (RVS) in which realtime ultrasound (US) images and reconstructive virtual US images of the same cross-section are synchronized based on US volume data obtained on the same monitor using magnetic position tracking system (US-RVS). The purpose of this study was to evaluate the accuracy of US-RVS to compare breast US images between different time phases.

Materials and Methods: Between March 2010 and April 2011, US-RVS was performed in 108 consecutive patients with 112 target lesions for US (mean lesion size: 12 mm, 54 malignant and 58 benign). We used US-RVS system which consisted of sonography equipment, magnetic field generator, magnetic sensor, and workstation. To assess the accuracy of the US-RVS, we analyzed the sonographic re-identification rate of target lesions in different time phases.

Results: Among the 112 target lesions, 105 (94%) lesions were re-identified by US-RVS. The remaining occult 7 (6%) lesions were included one DCIS and 6 fibrocystic changes in terms of the histological type, and one mass lesion and 6 nonmass like lesions in terms of morphological feature. US-RVS enabled us to precisely compare arbitrary cross-sections of US images in any direction between different time phases independent of the operator's skill.

Conclusion: US-RVS, which requires no contrast medium and involves no radiation exposure, can be a useful modality for temporally tracking regions of interest using US.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-10-10.

Effectiveness of high-dose barium enema filling for colonic diverticular bleeding

AIM

Therapeutic barium enema was first reported in 1970. The long-term recurrence rate of colonic diverticular bleeding after therapeutic barium enema was compared with that of endoscopic haemostasis.

METHOD

This study included 57 consecutive patients admitted between 2003 and 2008 with colonic diverticular bleeding in whom conservative treatment failed to stop bleeding within 3 h of hospital admission. Lower gastrointestinal endoscopy was performed immediately after admission. In 75% of patients, bleeding was from the right colon, and any identifiable source of bleeding was treated by endoscopic haemostasis. Cases with an undetectable source received high-dose barium impaction therapy.

RESULTS

Treatment was as follows: Group A (n = 37) solely by endoscopic haemostasis; Group B (n = 11) solely by therapeutic barium enema group, and Group C (n = 9) by endoscopic haemostasis and therapeutic barium enema. At a follow up of seven (median; range: 1-56) months, recurrent bleeding rates were 18/37 (48.6%), 6/11 (54.5%) and 2/9 (22.2%) (P = 0.3930).

CONCLUSION

High-dose barium enema is as effective as endoscopic haemostasis for the prevention of recurrent diverticular bleeding.

Smad ubiquitination regulatory factor-2 in progressive supranuclear palsy

AIMS

Smad ubiquitination regulatory factor-2 (Smurf2) is an E3 ligase that belongs to the HECT domain ubiquitin ligase family. Smurf2 can interact with Smad proteins and promote their ubiquitin-dependent degradation, thereby controlling the cellular levels of these signalling mediators. Phosphorylated Smad2/3 (pSmad2/3) was recently identified in phosphorylated tau (phospho-tau) inclusions in patients with progressive supranuclear palsy (PSP). As Smurf2 is the E3 ligase of pSmad2, we aimed at investigating the relationship among Smurf2, pSmad2/3 and phospho-tau in this study.

METHODS

The brains of six PSP and three control patients without neurological disorder were investigated by immunohistochemical analysis.

RESULTS

In the control subjects, Smurf2 immunoreactivity was not demonstrable in the neurones and glial cells, and that for pSmad2/3 was observed exclusively in neuronal and glial nuclei. In PSP patients, the pathognomonic neuronal and glial phospho-tau inclusions were immunopositive for both Smurf2 and pSmad2/3. The intensity of pSmad2/3 immunosignals of neuronal and glial nuclei containing phospho-tau inclusions was less than that for the cells without the inclusions. Triple immunofluorescence staining for Smurf2, pSmad2/3 and phospho-tau revealed co-localization of these proteins within the neuronal and glial inclusions; and in some globose neurofibrillary tangles, the Smurf2 immunoreactivity appeared more centrally distributed than that of pSmad2/3 and phospho-tau.

CONCLUSIONS

This is the first demonstration of the presence of Smurf2 immunoreactivity in the phospho-tau inclusions in PSP. These findings suggest that Smurf2 plays a significant role in the pathomechanism of PSP by causing abnormal redistribution of neuronal nuclear pSmad2/3 to the cytoplasm.