• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2673-2678
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• 2016

Background: It is unclear as to whether the size ratio elastographic technique is useful for assessing ultrasound-detected ductal carcinoma-in-situ (DCIS) masses since they commonly lack a significant desmoplastic reaction. The objectives of this study were to determine the accuracy of this elastographic technique in DCIS and examine if there was any histopathological correlation with the grey-scale strain patterns. Materials and Methods: Female patients referred to the radiology department for image-guided breast biopsy were prospectively evaluated by ultrasound elastography prior to biopsy. Histological diagnosis was the gold standard. An elastographic size ratio of more than 1.1 was considered malignant. Elastographic strain patterns were assessed for correlation with the DCIS histological architectural patterns and nuclear grade. Results: There were 30 DCIS cases. Elastographic sensitivity for detection of malignancy was 86.7% (26/30). 10/30 (33.3%) DCIS masses demonstrated predominantly white elastographic strain patterns while 20/30 (66.7%) were predominantly black. There were 3 (10.0%) DCIS masses that showed had a co-existent bull's-eye sign and 7 (23.3%) other masses had a co-existent toothpaste sign, a strain pattern that has never been reported in the literature. Four out of 4/5 comedo DCIS showed a predominantly white strain pattern (p=0.031) while 6/7 cases with the toothpaste sign were papillary DCIS (p=0.031). There was no relationship between the strain pattern and the DCIS nuclear grade. Conclusions: The size ratio elastographic technique was found to be very sensitive for ultrasound-detected DCIS masses. While the elastographic grey-scale strain pattern should not be used for diagnostic purposes, it correlated well with the DCIS architecture.

• Asian Pacific Journal of Cancer Prevention
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• 제15권1호
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• pp.55-60
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• 2014

Background: Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. Materials and Methods: 125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM). Results: 88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95%CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion. Conclusions: Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.3733-3736
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• 2016

HER2/neu is a well-established prognostic and predictive factor for invasive breast cancer. However, the role of HER2/neu in ductal breast carcinoma in situ (DCIS) is debated and recent data have suggested that it is mainly linked to in situ local recurrence. Although molecular data suggest that atypical ductal hyperplasia (ADH) and duct carcinoma in situ (DCIS) are related lesions, albeit with vastly different clinical implications, the role of HER2/neu expression in atypical ductal hyperplasia is not well defined either. The aim of this study was to evaluate over expression of HER2/neu in DCIS and cases of ADH in comparison with invasive breast carcinoma. Archival primary breast carcinoma paraffin blocks (n=15), DCIS only (n=10) and ductal epithelial hyperplasia and other breast benign lesions (n=25) were analyzed for HER2/neu immunoexpression. Follow up was available for 40% of the patients. HER2/neu was positive in 80%of both DCIS and invasive carcinoma, and 67% of atypical ductal hyperplasia (ADH) cases. Thus at least a subset of patients with preinvasive breast lesions were positive, which strongly suggests a role for Her2/neu in identifying high-risk patients for malignant transformation. Although these are preliminary data, which need further studies of gene amplification within these patients as well as a larger patient cohort with longer periods of follow up, they support the implementation of routine Her2/neu testing in patients diagnosed as pure DCIS and in florid ADH.

• Radiation Oncology Journal
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• 제32권1호
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• pp.1-6
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• 2014

Purpose: To evaluate the outcome of ductal carcinoma in situ (DCIS) patients who underwent surgery followed by radiation therapy (RT). Materials and Methods: We retrospectively reviewed 106 DCIS patients who underwent surgery followed by postoperative RT between 1994 and 2006. Ninety-four patients underwent breast-conserving surgery, and mastectomy was performed in 12 patients due to extensive DCIS. Postoperative RT was delivered to whole breast with 50.4 Gy/28 fx. Tumor bed boost was offered to 7 patients (6.6%). Patients with hormonal receptor-positive tumors were treated with hormonal therapy. Results: The median follow-up duration was 83.4 months (range, 33.4 to 191.5 months) and the median age was 47.8 years. Ten patients (9.4%) had resection margin <1 mm and high-grade and estrogen receptor-negative tumors were observed in 39 (36.8%) and 20 (18.9%) patients, respectively. The 7-year ipsilateral breast tumor recurrence (IBTR)-free survival rate was 95.3%. Resection margin (<1 or ${\geq}1$ mm) was the significant prognostic factor for IBTR in univariate and multivariate analyses (p < 0.001 and p = 0.016, respectively). Conclusion: Postoperative RT for DCIS can achieve favorable treatment outcome. Resection margin was the important prognostic factor for IBTR in the DCIS patients who underwent postoperative RT.

• Asian Pacific Journal of Cancer Prevention
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• 제15권7호
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• pp.3179-3183
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• 2014

Background: The purpose of study was to evaluate radiologic or clinical features of breast cancer undergoing ultrasound (US)-guided 14G core needle biopsy (CNB) and analyze the differences between underestimated and accurately diagnosed groups. Materials and Methods: Of 1,898 cases of US-guided 14G CNB in our institute, 233 cases were proven to be cancer by surgical pathology. The pathologic results from CNB were invasive ductal carcinoma (IDC) (n=157), ductal carcinoma in situ (DCIS) (n=40), high-risk lesions in 22 cases, and benign in 14 cases. Among high-risk lesions, 7 cases of atypical ductal hyperplasia (ADH) were reported as cancer and 11 cases of DCIS were proven IDC in surgical pathology. Some 29 DCIS cases and 157 cases of IDC were correctly diagnosed with CNB. The clinical and imaging features between underestimated and accurately diagnosed breast cancers were compared. Results: Of 233 cancer cases, underestimation occurred in 18 lesions (7.7%). Among underestimated cancers, CNB proven ADH (n=2) and DCIS (n=11) were diagnosed as IDC and CNB proven ADH (n=5) were diagnosed at DCIS finally. Among the 186 accurately diagnosed group, the CNB results were IDC (n=157) and DCIS (n=29). Comparison of underestimated and accurately diagnosed groups for BI-RADS category, margin of mass on mammography and US and orientation of lesion on US revealed statistically significant differences. Conclusions: Underestimation of US-guided 14G CNB occurred in 7.7% of breast cancers. Between underestimated and correctly diagnosed groups, BI-RADS category, margin of the mass on mammography and margin and orientation of the lesions on US were different.

• Korean Journal of Radiology
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• 제24권12호
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• pp.1190-1199
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• 2023

Objective: This study aimed to investigate the feasibility of ultrafast magnetic resonance imaging (MRI) and radiomic features derived from breast MRI for predicting the upstaging of ductal carcinoma in situ (DCIS) diagnosed using percutaneous needle biopsy. Materials and Methods: Between August 2018 and June 2020, 95 patients with 98 DCIS lesions who underwent preoperative breast MRI, including an ultrafast sequence, and subsequent surgery were included. Four ultrafast MRI parameters were analyzed: time-to-enhancement, maximum slope (MS), area under the curve for 60 s after enhancement, and time-to-peak enhancement. One hundred and seven radiomic features were extracted for the whole tumor on the first post-contrast T1WI and T2WI using PyRadiomics. Clinicopathological characteristics, ultrafast MRI findings, and radiomic features were compared between the pure DCIS and DCIS with invasion groups. Prediction models, incorporating clinicopathological, ultrafast MRI, and radiomic features, were developed. Receiver operating characteristic curve analysis and area under the curve (AUC) were used to evaluate model performance in distinguishing between the two groups using leave-one-out cross-validation. Results: Thirty-six of the 98 lesions (36.7%) were confirmed to have invasive components after surgery. Compared to the pure DCIS group, the DCIS with invasion group had a higher nuclear grade (P < 0.001), larger mean lesion size (P = 0.038), larger mean MS (P = 0.002), and different radiomic-related characteristics, including a more extensive tumor volume; higher maximum gray-level intensity; coarser, more complex, and heterogeneous texture; and a greater concentration of high gray-level intensity. No significant differences in AUCs were found between the model incorporating nuclear grade and lesion size (0.687) and the models integrating additional ultrafast MRI and radiomic features (0.680-0.732). Conclusion: High nuclear grade, larger lesion size, larger MS, and multiple radiomic features were associated with DCIS upstaging. However, the addition of MS and radiomic features to the prediction model did not significantly improve the prediction performance.

• 셀메드
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• 제2권2호
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• pp.18.1-18.16
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• 2012

An oncology-specific database called OncoRx (http://bit.ly/cancerRx) was previously set up in cyberspace to aid clinicians in identifying interactions of anticancer drugs (ACDs) and chemotherapy regimens with traditional Chinese medicines (TCMs) and complementary and alternative medicines (CAMs). Since then, users have requested the drug-CAM interactions (DCIs) of 5 specific CAMs (cranberry, melatonin, co-enzyme Q10, huachansu, reishi mushroom) to be updated in the database. Pharmacokinetic properties (metabolism, enzyme induction/inhibition, elimination), TCM properties and DCIs of each CAM were collated with 117 ACDs using 9 hardcopy compendia and online databases as resources. Additionally, individual ACDs and CAMs were used as keywords for PubMed searches in combination with the terms 'anticancer drugs', 'drug interactions', 'herb-drug/drug-herb interactions', 'pharmacokinetic interactions' and 'pharmacodynamic interactions'. DCI parameters consisted of interaction effects, evidence summaries, proposed management plans and alternative non-interacting CAMs, together with relevant citations and update dates of the DCIs. OncoRx is also used as a case to introduce the "Four Pharmaco-cybernetic Maxims" of quality, quantity, relationship and manner to developers of digital healthcare tools. Its role in Hayne's "5S" hierarchy of research evidence is also presented. OncoRx is meant to complement existing DCI resources for clinicians and alternative medicine practitioners as an additional drug information resource that provides evidence-based DCI information for ACD-CAM interactions.

• 한국방사선학회논문지
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• 제5권3호
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• pp.149-154
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• 2011

유방암중 관상피 내암으로 진단 받은 환자를 대상으로 확산강조 영상을 정량적으로 비교 분석하여 확산강조영상의 효과와 유용성을 고찰 해보고자 한다. 조직학적으로 관상피 내암으로 진단 받은 환자 20명을 대상으로 3.0T MR scanner를 이용하여 확산강조영상과 ADC map 영상을 획득하였다. 정량적 분석 결과 병변 부위와 정상부위의 신호대 잡음비와 대조도대 잡음비는 병변 조직에서 높은 신호대 잡음비와 대조도대 잡음비를 보였으며 병변 부위와 정상부위의 현성확산계수는 병변 조직에서 낮은 현성확산계수를 보였다.

• 핵의학기술
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• 제18권1호
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• pp.140-144
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• 2014

최근 유방암 환자의 급증은 여러 가지 통계로 보고되고 있다. 유방암의 발병부위는 크게는 유관, 소엽등으로 분류하고 그 중 85% 이상이 유관에서 발병되고 있다. 본 연구는 유관에서 발병되는 암의 종류를 분별하여 시간의 경과에 따라 변화되는 $SUV_{max}$의 차이를 알아보고자 하였다. 2012년 7월 1일부터 2013년 7월 22일까지 유방암 진단을 받고 본원 PET-CT센터를 방문한 여성 환자 291명을 대상으로 하였다. 병리학적 결과를 기준으로 IDC (invasive ductal carcinoma) 환자 248명과 DCIS (ductal carcinoma in situ) 환자 43명을 선별하였다. 일반 PET-CT 검사와 동일한 방법(3.7 MBq/kg)으로 $F^{18}-FDG$를 주사 후 1시간 경과 후 1차 검사(routine 검사)를 진행하였고 또 한 번의 1HR 경과 후 2차 검사 (Delay검사)를 진행하였다. 2회 진행된 검사 Data를 토대로 하여 병소부위에 ROI를 설정하여 $SUV_{max}$를 측정하였다. IDC와 DCIS의 두집단의 병소 $SUV_{max}$의 변화를 비교 확인한 결과 IDC의 경우 $SUV_{max}$값이 1차 검사에서는 M=7.11, SD=5.405이고 2차 검사에서는 M=8.363, SD=6.624으로 상승(P<0.05)하였으며, DCIS의 경우 $SUV_{max}$는 1차 검사에서는M=2.739, SD=1.229이고 2차 검사에서는 M=2.614, SD=1.470으로 감소(P<0.05)하였다. 결 론: IDC와 DCIS의 시간에 따른 $SUV_{max}$의 결과를 비교해본 결과 IDC에서는 1차 검사(routine검사)보다 2차 검사(Delay검사)에서 $SUV_{max}$가 상승(P=0.000)함을 확인하였고 DCIS에서는 1차 검사(roution검사)보다 2차 검사(Delay검사)에서 $SUV_{max}$값이 감소(P=0.039)함을 확인하였다. 본 연구를 통해 유관에서 발병되는 유방암의 종류(IDC와 DCIS)별 시간경과에 따라 $SUV_{max}$의 변화가 발생함을 확인하였다.

• 한국정보과학회:학술대회논문집
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• 한국정보과학회 2001년도 가을 학술발표논문집 Vol.28 No.2 (2)
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• pp.340-342
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• 2001

본 논문은 유방질환 중에서 Duct(관)에 발생하는 유방 종양을 benign(양성종양)/DCIS (Ductal Carcinoma In Situ)/NOS(Invasive ductal carcinoma)로 자동 분류하기 위한 분류방법을 제안한다. 분류기 생성에서 가장 중요한 단계인 특징 추출단계에서는 wavelet 변환을 적용하였으며, wavelet 변환의 각 depth에 따라 분류기를 생성하여, depth와 생성된 분류기의 분류 정확도와의 상관관계를 비교.분석하였다. 현미경 100배 배율과 400배 배율의 유방 질환 영상을 1, 2, 3, 4단계(depth)의 wavelet 변환을 적용한 후, 분할된 서브밴드에서 GLCM을 이용하여 질감 특징(Entropy, Energy, Contrast, Homogeneity)을 추출하여, 이 특징값들을 조합하여 판별분석에 의해 분류기(classifier)를 생성한 후, 분류 정확도를 검증하였다. Benign/DCIS/NOS를 분류하려면 최소 3단계 이상의 wavelet 변환을 적용해야 하고, 400배 배율 영상보다는 100배 배율의 영상이 더 나은 결과를 보였다.