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Purpose18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) is related to the biological parameters and prognosis of breast cancer. However, whether whole-body PET (WBPET) and dedicated breast PET (DbPET) can reflect the tumor microenvironment is unclear. This study investigated the relationship between stromal tumor-infiltrating lymphocytes (TILs) and maximum standardized uptake value (SUVmax) in WBPET and DbPET.MethodsA total of 125 invasive breast cancers underwent WBPET and ring-type DbPET and resected specimens were pathologically assessed. The impact of SUVmax on the tumor biological parameters and TILs was retrospectively evaluated. SUVmax was classified as high and low relative to the median values (WBPET-SUVmax: 2.2 and DbPET-SUVmax: 6.0).ResultsSUVmax correlated with tumor size, nuclear grade, Ki-67 labeling index, and TILs in both WBPET and DbPET (all p < 0.001). In multiple linear regression analysis, tumor size, Ki-67 labeling index, and TILs predicted SUVmax in WBPET and DbPET. The cutoff values of tumor size, Ki-67 labeling index, and TILs predicting high SUVmax were 20 mm, 20%, and 20%, respectively. In multivariate analysis, the predictive factors for high SUVmax were tumor size and Ki-67 labeling index for WBPET and tumor size and TILs for DbPET. High SUVmax in DbPET was related to high numbers of TILs after propensity score matching analysis; however, WBPET was not (p = 0.007 and p = 0.624, respectively).ConclusionsBoth SUVmax values in WBPET and DbPET predicted TIL concentration of the primary breast cancer. In DbPET, SUVmax represented the immune microenvironment after adjusting for tumor biological factors.

Purpose FOXP3 + and CD8 + are recognized markers of tumor-infiltrating lymphocytes (TILs) for breast cancer. FOXP3 + TILs are composed of effector Tregs (eTregs) and other subpopulations that are classified by their differences in suppressive function. In this prospective study, we evaluated Treg subpopulations and CD8 + TILs in breast cancer. Methods 84 patients with breast cancer were enrolled. Fresh TILs were extracted andTregs were classified into eTregs (CD4 + FOXP3 high CD45RA − ), other FOXP3 + Treg subsets (naïve and non-Tregs), and total CD8 + CD4 − TILs using flow cytometry. The suppression strength of each Treg subpopulation was analyzed. The association between TIL subpopulations, clinicopathological characteristics, and response to chemotherapy was evaluated. Results The mean CD8/eTreg ratio value was 7.86 (interquartile range: 4.08–12.80). The proliferation function of eTregs was significantly suppressed compared with that of the other subpopulations (proliferation rates: control: 89.3%, + naiiveTreg: 64.2%, + non-Treg: 78.2% vs eTreg 1.93%; all P < 0.05). The patients with high with a high CD8 + /eTreg ratio achieved excellent pathological complete response (pCR) rate of neoadjuvant chemotherapy (90.2%) and the CD8/eTreg ratio were independent predictive factors for pCR (odds ratio:18.7(confidence interval 1.25–279) P < 0.05). A detailed assessment of the CD8/eTreg ratio for each patient who underwent NAC revealed that high CD8/eTreg ratio showed a significantly higher pCR rate compared to patients with a low CD8/FOXP3 ratio (39.6% vs 13.3, P < 0.05) in triple negative subtype patients with stromal TILs < 50%. Conclusions A high CD8/eTreg ratio enhances pCR rate in patients with invasive breast cancer.

PurposeThe aim of this study was to assess whether the retention index (RI) determined using dual-phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) reflects the malignant features of breast cancer.MethodsA total of 1,523 patients with breast cancer were retrospectively evaluated. PET/CT scans were performed at 1 h and 2 h after FDG administration before treatment. The maximum standardized uptake value (SUVmax) at both time points (SUVmax1 and SUVmax2) in the primary tumour and RI were calculated. Primary tumour tissues were evaluated in terms of biological features, such as histology, nuclear grade, lymphovascular invasion and molecular subtype.ResultsOf the 1,523 patients, 463 (30.4%) had luminal A-like, 661 (43.4%) had luminal B-like, 229 (15.0%) had human epidermal growth factor receptor 2-positive (HER2-positive), and 157 (10.3%) triple-negative breast cancer. The median SUVmax1, SUVmax2 and RI values were 2.2, 2.3 and 2.6%, respectively. These metabolic parameters were correlated with tumour size, nodal metastasis, histology, nuclear grade, lymphovascular invasion, and molecular subtype (all P < 0.001). The median RI values were 0% in luminal A-like, 5.3% in luminal B-like, 6.9% in HER2-positive, and 11.4% in triple-negative breast cancer. RI was associated with malignant features when the tumour accumulated a significant amount of FDG. In a subanalysis of patients with tumours of stages T2 to T4, RI was correlated with nodal metastasis, histology, nuclear grade, and molecular subtype (luminal A-like 4.8%, luminal B-like 12.3%, HER2-positive 15.8%, and triple-negative 16.3%).ConclusionRI determined using delayed-phase FDG PET/CT is associated with malignant features in breast cancers with significant FDG uptake. Dual-phase imaging was helpful in distinguishing luminal A-like breast cancer from luminal B-like, HER2-positive, and triple-negative breast cancers.

The characteristics of different breast cancers imaged using dual-energy computed tomography (DECT) are unknown. Furthermore, the differences between DECT and magnetic resonance imaging (MRI) in the ability to assess tumor extent have not been clarified. Therefore, this study aimed to evaluate the effectiveness of DECT iodine maps compared to contrast-enhanced MRI in patients with operable breast cancer.BACKGROUND/AIMThe characteristics of different breast cancers imaged using dual-energy computed tomography (DECT) are unknown. Furthermore, the differences between DECT and magnetic resonance imaging (MRI) in the ability to assess tumor extent have not been clarified. Therefore, this study aimed to evaluate the effectiveness of DECT iodine maps compared to contrast-enhanced MRI in patients with operable breast cancer.Clinicopathological data from 858 patients with breast cancer who underwent resection after DECT (100/140 kv) and MRI during 2012-2021 were collected. Tumoral iodine concentration (IC; max/Δ) was analyzed from iodine maps. Factors associated with the ability of iodine maps and MRI to predict tumor extent were analyzed with reference to resected specimens' pathological diagnosis.PATIENTS AND METHODSClinicopathological data from 858 patients with breast cancer who underwent resection after DECT (100/140 kv) and MRI during 2012-2021 were collected. Tumoral iodine concentration (IC; max/Δ) was analyzed from iodine maps. Factors associated with the ability of iodine maps and MRI to predict tumor extent were analyzed with reference to resected specimens' pathological diagnosis.IC parameters varied according to the tumors' histological types and were correlated with the estrogen receptor, histological grade, and Ki-67 labeling index. In 86.2% of patients with invasive carcinoma with intraductal extension, images and resected specimen mapping were matched. Iodine maps were less accurate than MRI in identifying tumor borders in 9.8% and more accurate in 2.1% of patients. The discrepancies in assessing tumor borders between imaging modalities were associated with the tumor's IC parameters and mammary gland status.RESULTSIC parameters varied according to the tumors' histological types and were correlated with the estrogen receptor, histological grade, and Ki-67 labeling index. In 86.2% of patients with invasive carcinoma with intraductal extension, images and resected specimen mapping were matched. Iodine maps were less accurate than MRI in identifying tumor borders in 9.8% and more accurate in 2.1% of patients. The discrepancies in assessing tumor borders between imaging modalities were associated with the tumor's IC parameters and mammary gland status.Differences in assessment between DECT and MRI in operable breast cancer are associated with IC parameters and background parenchymal enhancement. Therefore, evaluating tumor extent using DECT considering these characteristics appears to be a feasible approach.CONCLUSIONDifferences in assessment between DECT and MRI in operable breast cancer are associated with IC parameters and background parenchymal enhancement. Therefore, evaluating tumor extent using DECT considering these characteristics appears to be a feasible approach.

Triple-negative breast cancer (TNBC) is characterized by an active immune response. We evaluated intratumoral interrelation between FOXP3+ tumor-infiltrating lymphocytes and other cytokines in TNBC. Network analysis refined cytokines significantly correlate with FOPX3 in TNBC. Information on the treatment response and prognosis of patients, and survival data from the TGCA and METABRIC databases were analyzed according to refined cytokines. Interleukin (IL)-33 was significantly expressed by TNBC cell lines compared to luminal cell lines (log2 fold change: 5.31, p < 0.001) and IL-33 and TGFB2 showed a strong correlation with FOXP3 in the TNBC cell line. Immunohistochemistry demonstrated that the IL-33 high group was a significant predictor of complete response of neoadjuvant chemotherapy (odds ratio (OR) 4.12, p < 0.05) and favorable survival compared to the IL-33 low group (OR 6.48, p < 0.05) in TNBC. Survival data from TGCA and METABRIC revealed that FOXP3 was a significantly favorable marker in the IL-33 high group compared to the low IL-33 low group (hazard ratio (HR) 2.1, p = 0.02), and the IL-33 high/TGFB2 high subgroup showed significant favorable prognosis in the FOXP3 high group compared to the FOPX3 low group in TNBC (HR 3.5, p = 0.01). IL-33 and TGFB2 were key cytokines of intratumoral interrelation among FOXP3 in TNBC.

Recent studies have demonstrated that breast pathological complete response (pCR) can be accurately diagnosed preoperatively using image-guided needle biopsy after neoadjuvant chemotherapy (NAC), underscoring the value of incorporating ypT stage into prediction models for axillary response (ypN0). Based on this evidence, we developed and externally validated a nomogram to predict ypN0 in patients with clinically node-positive (cN+) breast cancer treated with NAC. This retrospective, multicenter study included 609 patients with cN + breast cancer who underwent NAC followed by surgery. A nomogram was developed using a training cohort (n = 330) and validated in an independent cohort (n = 279). Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and positive predictive value (PPV). The nomogram incorporated five predictors: ypT stage, cN stage, hormone receptor status, HER2 status, and post-NAC cN stage. It showed strong discriminative ability, with bias-corrected AUCs of 0.858 in the training cohort and 0.855 in the validation cohort. Calibration and DCA confirmed good model performance. PPV exceeded 0.90 when the nomogram-predicted probability was ≥ 0.7 in both cohorts. This nomogram demonstrated high diagnostic accuracy for predicting ypN0 and may support the selection of candidates for axillary surgery de-escalation based on post-NAC biopsy findings. Prospective validation using biopsy-confirmed pCR is warranted.

Morgagni hernia is a rare form of diaphragmatic hernia. It is located at the anterior edge of the diaphragm and does not have an anterior rim. It is difficult to achieve a secure closure and maintain the tension of closure with laparoscopic surgery. We have performed laparoscopic resection of colorectal cancer and hernia repair simultaneously. An 89-year-old woman underwent laparoscopic hernia repair and ileocecal resection simultaneously. Regarding hernia repair, we considered that it would be difficult to use a mesh from the viewpoint of infection due to the colectomy. Therefore, we have done the extra-abdominal suture method. After laparoscopic ileocecal resection, a small incision was made in the epigastric region, and Morgagni hernia repair was performed with extra-abdominal sutures. She had no recurrence of either colon cancer or hernia for 22 months post-operatively. The extra-abdominal suture method can provide secure closure of the hernia orifice for Morgagni hernia.

Pyopneumothorax is a rare but troubling complication of bevacizumab. We herein report a case of pyopneumothorax in a patient with metastatic breast cancer during bevacizumab treatment. A 60-year-old female who was diagnosed with metastatic breast cancer (ER+ , PgR+ , HER2-, Ki67 <14 %, metastasized to lung, pleural, brain, subcutaneous tissue, and bone) was started on bevacizumab plus paclitaxel chemotherapy. Although the disease was well-controlled, pyopneumothorax was noted after 3 months of treatment and the chemotherapy was therefore stopped immediately. The pyopneumothorax was so intractable that no conservative treatment could successfully manage it. The patient underwent a radical operation using the technique of latissimus dorsi muscle transfer. The operation improved her general condition and lead to hormonal therapy. Our case indicates the successful management of a severe side effect of bevacizumab for a breast cancer patient.