Magnetic resonance imaging and ultrasound for prediction of residual tumor size in early breast cancer within the ADAPT subtrials

Background

Prediction of histological tumor size by post-neoadjuvant therapy (NAT) ultrasound and magnetic resonance imaging (MRI) was evaluated in different breast cancer subtypes.

Methods

Imaging was performed after 12-week NAT in patients enrolled into three neoadjuvant WSG ADAPT subtrials. Imaging performance was analyzed for prediction of residual tumor measuring ≤10 mm and summarized using positive (PPV) and negative (NPV) predictive values.

Results

A total of 248 and 588 patients had MRI and ultrasound, respectively. Tumor size was over- or underestimated by < 10 mm in 4.4% and 21.8% of patients by MRI and in 10.2% and 15.8% by ultrasound. Overall, NPV (proportion of correctly predicted tumor size ≤10 mm) of MRI and ultrasound was 0.92 and 0.83; PPV (correctly predicted tumor size > 10 mm) was 0.52 and 0.61. MRI demonstrated a higher NPV and lower PPV than ultrasound in hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-positive and in HR−/HER2+ tumors. Both methods had a comparable NPV and PPV in HR−/HER2− tumors.

Conclusions

In HR+/HER2+ and HR−/HER2+ breast cancer, MRI is less likely than ultrasound to underestimate while ultrasound is associated with a lower risk to overestimate tumor size. These findings may help to select the most optimal imaging approach for planning surgery after NAT.

Trial registration

Clinicaltrials.gov, NCT01815242 (registered on March 21, 2013), NCT01817452 (registered on March 25, 2013), and NCT01779206 (registered on January 30, 2013).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13058-021-01413-y.

Digital pen technology for conducting cognitive assessments: a cross-over study with older adults

Many digitalized cognitive assessments exist to increase reliability, standardization, and objectivity. Particularly in older adults, the performance of digitized cognitive assessments can lead to poorer test results if they are unfamiliar with the computer, mouse, keyboard, or touch screen. In a cross-over design study, 40 older adults (age M = 74.4 ± 4.1 years) conducted the Trail Making Test A and B with a digital pen (digital pen tests, DPT) and a regular pencil (pencil tests, PT) to identify differences in performance. Furthermore, the tests conducted with a digital pen were analyzed manually (manual results, MR) and electronically (electronic results, ER) by an automized system algorithm to determine the possibilities of digital pen evaluation. ICC(2,k) showed a good level of agreement for TMT A (ICC(2,k) = 0.668) and TMT B (ICC(2,k) = 0.734) between PT and DPT. When comparing MR and ER, ICC(2,k) showed an excellent level of agreement in TMT A (ICC(2,k) = 0.999) and TMT B (ICC(2,k) = 0.994). The frequency of pen lifting correlates significantly with the execution time in TMT A (r = 0.372, p = 0.030) and TMT B (r = 0.567, p < 0.001). A digital pen can be used to perform the Trail Making Test, as it has been shown that there is no difference in the results due to the type of pen used. With a digital pen, the advantages of digitized testing can be used without having to accept the disadvantages.

Trace Analytical Capabilities of Total-Reflection X-ray Fluorescence Analysis

The principle to utilize total reflection of the primary X-rays in fluorescence analysis is known since a lot of years. Nevertheless, analytical chemistry did not profit from the inherent advantages of the method for a long time. The main reason for this failure was the lack of instruments which were easy to use in practice. A few years ago, however, the development of a proper mechanical design and of adapted sample preparation techniques led to commercially available spectrometers which throughout fulfill the demands for routine applications. Since then the utilization of Total-Reflection X-Ray Fluorescence Analysis (TXRF) has increased rapidly. The scope of work is meanwhile widespread over environmental research and monitoring, mineralogy, mineral exploration, oceanography, biology, medicine and biochemistry. Accordingly, numerous matrices have been handled.

Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval

PURPOSE

 Assessment of age group-dependent detection rates of invasive breast cancers among participants in mammography screening including the interval, classified into immunohistochemical subtypes indicating the intrinsic tumor aggressiveness.

MATERIALS UND METHODS

 The target population comprises women aged 50 - 69 years. All invasive breast cancers diagnosed in one screening (sc) unit during the implementation phase 1/2006 - 12/2010 or identified by the cancer registry during the biennial interval (iv) were categorized based on hormonal-receptor status (HR) and Her2-expression (Her2) into the following subtypes: a) HR+ Her2-, b) HR+ Her2 +, c) HR- Her2 + or d) HR- Her2- (triple-negative); Her2 + and triple-negative types were defined as aggressive. The calculated detection rates (DR, ‰) were based on 53 375 sc-examinations and for the interval on 52 887 sc-negative examinations.

RESULTS

 The DRs of all subtypes were higher in screening versus the interval: (a) 4.95 ‰ (n = 264) vs. 1.00 ‰ (n = 53); b) 0.92 ‰ (n = 49) vs. 0.25 ‰ (n = 13); c) 0.36 ‰ (n = 19) vs. 0.06 ‰ (n = 3); d) 0.39 ‰ (n = 21) vs. 0.19 ‰ (n = 10). 77.4 ‰ (89/115) of all aggressive breast cancers including the following 2-year interval were diagnosed by screening. The sum of the DR of aggressive cancers was 1.67 ‰ in screening and 0.49 ‰ in the interval; the corresponding DRs for women aged 60 - 69 years [sc: 2.24 ‰ (51/22 814), iv: 0.58 ‰ (13/22 536)] were higher than among women aged 50 - 59 years [sc: 1.24 ‰ (38/30 561), iv: 0.43 ‰ (13/30 351)].

CONCLUSION

 Screening has the potential for earlier diagnosis of aggressive tumor types as its detection rate is about three-fold higher compared to the interval. Within the target group, participants aged 60 - 69 years are at risk based on absolute numbers. They show a nearly two-fold higher detection rate of Her2-positive or triple-negative tumors compared to the age group 50 - 59 years.

KEY POINTS

  · Her2-positive and triple-negative detection rates are higher in screening than in the interval.. · 77 % of aggressive subtypes are diagnosed by screening, 23 % during the 2-year interval.. · The detection rate is highest among women aged 60 - 69 years in screening..

CITATION FORMAT

· Prange A, Bokhof B, Polzer P et al. Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval. Fortschr Röntgenstr 2019; 191: 130 - 136.

Acute phase protein haptoglobin in blood plasma samples of harbour seals (Phoca vitulina) of the Wadden Sea and of the isle Helgoland

Haptoglobin (Hp) which is synthesized in response to infection, inflammation, trauma or toxicological damage is known as a major acute phase protein in numerous species. Quantification of the circulating concentration of this protein can provide an objective measure of the health status, but there is a lack of investigations on harbour seals. We investigated the Hp concentration in samples of 123 seals (Phoca vitulina) from the German and Danish Wadden Sea to study physiological ranges of Hp levels. Hp levels between 2002, the end of the phocine distemper virus epidemic (PDV), and 2007 were considered, and Hp concentrations between animals of different sex, ages as well as living areas were compared. Furthermore, as a case study, six animals from the open sea isle Helgoland were investigated in 2006. Influences on the health status of the seal population e.g. the PDV epidemic were reflected by increased Hp levels in North Sea seals in 2002. The results of the Wadden Sea seals showed no significant age-, sex-, or geographical area-related differences. Interestingly, for the seals of the open sea isle Helgoland higher Hp values were measured compared to the Wadden Sea seals. The present study demonstrates that Hp can be used as a diagnostic tool to monitor the health status of harbour seals.

Glycolipids from a colloid chemical point of view

Glycolipids are a group of compounds with a broad range of applications. Two types of glycolipids (alkylpolyglycosides and gangliosides) were examined with regard to their physicochemical properties. Despite their structural differences, they have in common that they are amphiphilic molecules and able to aggregate to form monolayers, bilayers, micelles, lyothropic mesophases or vesicles. The structures of glycolipid micelles were investigated by different experimental techniques in addition to molecular dynamic simulations. The knowledge of the physicochemical properties of gangliosides enables a better understanding of their biological functions. Structural features were obtained for the monosialogangliosides GM1, GM2 and GT1b from bovine brain by means of mass spectrometry. Further the aggregation behaviour was determined by small-angle neutron and dynamic light scattering experiments. Interaction studies of these compounds were carried out by means of surface plasmon resonance using gangliosides incorporated liposomes. They were used as model membranes that interact with the lectins WGA, RCA and HPA. The interaction of lectins immobilized to a modified silicon surface was investigated by in-situ ellipsometry.

Fusarium spp. and storage fungi in suboptimally stored wheat: Mycotoxins and influence on wheat gluten proteins

When wheat is stored under suboptimal conditions, a further mycotoxin increase of deoxynivalenol (DON), but especially of mycotoxins produced by storage fungi, e.g. ochratoxin A, is possible, lowering wheat quality and food safety. Different storage trials were conducted under suboptimal storage conditions.Fusarium survival during suboptimal storage was monitored by cultural technique and multiplex-PCR and set into relation to DON contents. Furthermore, XANES spectroscopy was applied on a selected storage trial in order to characterize sulfur speciation in low molecular weight (LMW) subunits of glutenin isolated from suboptimally stored wheat samples highly infected withFusarium and from wheat infected withAspergillus andPenicillium. Distinct changes in sulfur speciation were observed in grains infected with storage fungi, especially a significant increase of higher oxidation states (sulfoxide state, sulfonate state).

Characterization of elemental pollution and its variations in sediments and suspended particulate matter from the River Elbe via multi-element analysis combined with chemometric data evaluation

Sediments and suspended particulate matter taken from about 100 sampling sites along the River Elbe from the source to the mouth during the period 1992 and 1998 have been analyzed for the concentrations of more than 60 elements in each sample. The analytical data were subsequently processed by means of multivariate statistics in order to characterize the charge of the River Elbe with inorganic pollutants to elucidate pollution trends. Using factor analysis 18 elements were found to be enriched by human activities. By means of cluster analysis--using the 18 anthropogenically influenced elements as variables--the sampling sites were aggregated into groups having similar element distributions. Thus, the entire stretch of the River Elbe was divided into three sections of characteristic elemental pollution. Finally, the trends in anthropogenic pollution within the characteristic regions since the early nineties were assessed. It turned out that most of the anthropogenically influenced elements showed a decrease in the upper and middle parts of the river, whereas no decrease could be verified in the estuary region.

Species analysis of metallothionein isoforms in human brain cytosols by use of capillary electrophoresis hyphenated to inductively coupled plasma-sector field mass spectrometry

A new approach for the speciation of metallothioneins (MT) in human brain cytosols is described. The analysis is performed by application of a newly developed coupling of capillary electrophoresis (CE) with inductively coupled plasma-sector field mass spectrometry (ICP-SFMS). Isoforms of metallothioneins are separated from 30-100 microliter sample volumes by CE and the elements Cu, Zn, Cd, and S are detected by use of ICP-SFMS. The extraction of cytosols is the first step in the analytical procedure. Tissue samples from human brain are homogenized in a buffer solution and submitted to ultra-centrifugation. The supernatant is defatted and the cytosol pre-treatment is optimized for CE separation by matrix reduction. The buffer concentration and pH used for capillary electrophoretic separation of metallothionein from rabbit liver were optimized. CE with ICP-MS detection is compared to UV detection. In the electropherograms obtained from the cytosols three peaks can be assigned to MT-1, MT-2, and MT-3. As an additional method, size-exclusion chromatography (SEC) is applied. Fractions from an SEC separation of the cytosol are collected, concentrated, and then injected into the CE. The detection of sulfur by ICP-SFMS (medium resolution mode) and quantification by isotope dilution have also been investigated as a new method for the quantification of MT isoforms. The analytical procedure developed has been used for the first time in comparative studies of the distributions of MT-1, MT-2, and MT-3 in brain samples taken from patients with Alzheimer's disease and from a control group.

Deoxynivalenol and ochratoxin A in German wheat and changes of level in relation to storage parameters

The occurrence of the mycotoxins deoxynivalenol (DON) and ochratoxin A (OTA) in the winter wheat of 1997 and 1998 grown under organic farming conditions was investigated using ELISAs (R-Biopharm) for quantification. The influence of delayed drying of the grain after harvest on the development of DON and OTA was determined in storage trials (moisture: 17% and 20%; temperature: 20 degrees C; duration: four and six weeks). The Tox5 PCR assay was used both to detect Fusarium species with the potential to produce trichothecenes and as a measure of their relative DNA content during the storage trials. The intensity of the PCR signals was correlated with the DON concentration. Fusarium species were identified microscopically by standard methods. All the freshly harvested grain samples were contaminated with DON and showed further increases in the DON concentration during storage. OTA contamination was found in 14.3% of the 1997 samples and in 24.1% of the 1998 samples. OTA increased during storage trials of the 1997 samples but not in the 1998 samples.

Stability studies of arsenic, selenium, antimony and tellurium species in water, urine, fish and soil extracts using HPLC/ICP-MS

The stability of arsenic, selenium, antimony and tellurium species in water and urine (NIST SRM 2670n) as well as in extracts of fish and soil certified reference materials (DORM-2 and NIST SRM 2710) has been investigated. Stability studies were carried out with As(III), As(V), arsenobetaine, monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), phenylarsonic acid (PAA), Se(IV), Se(VI), selenomethionine, Sb(III), Sb(V) and Te(VI). Speciation analysis was performed by on-line coupling of anion exchange high-performance liquid chromatography (HPLC) with inductively coupled plasma mass spectrometry (ICP-MS). Best storage of aqueous mixtures of the examined species was achieved at 3 degrees C whereas at -20 degrees C species transformation especially of selenomethionine and Sb(V) took place and a new selenium species appeared within a period of 30 days. Losses and species transformations during extraction processes were investigated. Extraction of the spiked fish material with methanol/water led to partial conversion of Sb(III), Sb(V) and selenomethionine to two new antimony and one new selenium species. The other arsenic, selenium and tellurium species were almost quantitatively extracted. For soil spiked with MMA, PAA, Se(IV) and Sb(III), recoveries after extraction with water and sulfuric acid (0.01 mol/L) were below 20%.

In situ analysis of sulfur in the sulfur globules of phototrophic sulfur bacteria by X-ray absorption near edge spectroscopy

During the oxidation of sulfide and thiosulfate purple and green sulfur bacteria accumulate globules of 'elemental' sulfur. Although essential for a thorough understanding of sulfur metabolism in these organisms, the exact chemical nature of the stored sulfur is still unclear. We applied sulfur K-edge X-ray absorption near edge spectroscopy (XANES) to probe the forms of sulfur in intact cells. Comparing XANES spectra of Allochromatium vinosum, Thiocapsa roseopersicina, Marichromatium purpuratum, Halorhodospira halophila and Chlorobium vibrioforme grown photolithoautotrophically on sulfide with reference probes (fingerprint method), we found sulfur chains with the structure R-S(n)-R. Evidence for the presence of sulfur rings, polythionates and anionic polysulfides in the sulfur globules of these bacteria was not obtained.

Troglitazone, an insulin action enhancer, improves glycaemic control and insulin sensitivity in elderly type 2 diabetic patients

The management of Type 2 diabetes mellitus with currently available oral agents may be complicated in the elderly by an increased frequency of side-effects. The effects of troglitazone, an insulin action enhancer, were studied in elderly patients with Type 2 diabetes in a double-blind, parallel-group, placebo-controlled trial. A total of 229 patients (41% male), mean age 75 (range 69-85) years, with two fasting capillary blood glucose values > or =7 and < or =15 mmol l(-1) (and within 4.0 mmol l(-1) of each other) and previously treated with either diet alone (30%) or oral hypoglycaemic agents, were randomized to placebo or troglitazone 400 mg once daily or 200 mg twice daily, or 800 mg once daily or 400 mg twice daily, for 12 weeks. After 12 weeks' treatment, fasting serum glucose was significantly lower in troglitazone-treated patients (troglitazone, adjusted geometric mean 9.4-10.4 mmol l(-1) vs placebo 12.7 mmol l(-1), p < 0.001). Adjusted geometric mean fructosamine was also lower in troglitazone-treated patients by 5 to 15% compared to placebo (P < 0.05 at all doses except 400 mg od). There was no significant difference between troglitazone doses for improvement in glycaemic control. Troglitazone lowered adjusted geometric mean fasting plasma insulin by 27-34% compared to placebo (P < 0.001) and insulin sensitivity (HOMA-S) improved by 9-15% in all troglitazone dose groups (p < 0.001). Troglitazone also lowered serum non-esterified fatty acids and triglyceride. Adverse event incidence in troglitazone-treated patients was similar to that in patients treated with placebo. No weight gain or symptomatic hypoglycaemia was recorded at any of the doses studied. Troglitazone is effective and well tolerated in elderly patients with Type 2 diabetes mellitus, providing improved glycaemic control in the absence of weight gain.