A nested case-control study on female breast cancer risk among medical diagnostic X-ray workers in China

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单侧乳腺癌放疗中健侧乳腺受照剂量及其诱发癌症风险预测

目的 分析单侧乳腺癌放疗所致健侧乳腺的剂量,并估算放疗诱发健侧乳腺癌的风险。方法 在同一医院调查49例接受单侧乳腺放疗患者的基本情况,从治疗计划系统上获取其健侧乳腺的辐射剂量并进行统计分析;利用美国电离辐射生物效应委员会报告Ⅶ第2部分（BEIR Ⅶ phase 2）推荐的风险模型,结合我国人口寿命表,预测不同年龄段单侧乳腺癌患者接受放疗诱发健侧乳腺癌的风险。结果 患者的处方剂量均为50 Gy,健侧乳腺的平均剂量为（1.21±0.89）Gy （0.14~3.59 Gy）,最大点剂量平均为（17.42±13.20）Gy （0.98~45.27 Gy）;健侧乳腺的最大点剂量和平均剂量变化幅度大,且有显著相关性（R=0.527,P=0.000）,不同年龄段患者的健侧乳腺平均剂量差异无统计学意义（P>0.05）。基于健侧乳腺的平均剂量,估算出受照年龄为35、40、50、60、70和80岁患者的健侧乳腺癌终生归因风险分别为2 449/10万人、1 857/10万人、994/10万人、446/10万人、173/10万人和55/10万人。结论 患者接受单侧乳腺癌放疗过程中,其健侧乳腺剂量可达1 Gy水平,可能增加健侧乳腺癌发生风险对年轻患者不容忽视,在制定放射治疗计划时应尽可能控制对患者健侧乳腺的照射。     

Time-driven activity-based costing of a novel form of CT-guided high-dose-rate brachytherapy intraoperative radiation therapy compared with conventional breast intraoperative radiation therapy for early stage breast cancer

IntroductionIntraoperative radiation therapy is an emerging option for adjuvant therapy for early stage breast cancer, although it is not currently considered standard of care in the United States. We applied time-driven activity-based costing to compare two alternative methods of breast intraoperative radiation therapy, including treatment similar to the techniques employed in the TARGIT-A clinical trial and a novel version with CT-guidance and high-dose-rate (HRD) brachytherapy.Methods and MaterialsProcess maps were created to describe the steps required to deliver intraoperative radiation therapy for early stage breast cancer at each institution. The components of intraoperative radiation therapy included personnel, equipment, and consumable supplies. The capacity cost rate was determined for each resource. Based on this, the delivery costs were calculated for each regimen. For comparison across centers, we did not account for indirect facilities costs and interinstitutional differences in personnel salaries.ResultsThe CT-guided, HRD form of intraoperative radiation therapy costs more to deliver ($4,126.21) than the conventional method studied in the TARGIT-A trial ($1,070.45). The cost of the brachytherapy balloon applicator ($2,750) was the primary driver of the estimated differences in costs. Consumable supplies were the largest contributor to the brachytherapy-based approach, whereas personnel costs were the largest contributor to costs of the standard form of intraoperative radiation therapy.ConclusionsWhen compared with the more established method of intraoperative radiation therapy using a portable superficial photon unit, the delivery of treatment with CT guidance and HDR brachytherapy is associated with substantially higher costs. The excess costs are driven primarily by the cost of the disposable brachytherapy balloon applicator and, to a lesser extent, additional personnel costs. Future work should include evaluation of a less expensive brachytherapy applicator to increase the anticipated value of brachytherapy-based intraoperative radiation therapy.     

雌激素受体诱导乳腺癌细胞辐射抗性的机制研究

目的 探讨雌激素受体(ESR1)对乳腺癌细胞辐射抗性的影响及分子机制。方法 在雌激素受体阴性乳腺癌细胞中转染ESR1过表达质粒(过表达对照vector组、过表达ESR1 OE组),在雌激素受体阳性乳腺癌细胞中通过慢病毒转染方法构建稳定敲低ESR1(敲低对照shNC组、敲低shESR1组)的细胞模型,采用实时荧光定量聚合酶链式反应(qPCR)和免疫印迹方法检测自噬相关基因mRNA(ATG5)和蛋白表达水平(LC3B-I、LC3B-II、P62、FIP200、ATG5、ATG7、ATG12、Beclin1、ULK1);在8 Gy X射线的电离辐射处理下,免疫印迹法检测自噬通量;采用流式细胞术检测细胞死亡;采用集落形成实验检测乳腺癌细胞辐射敏感性(未照射sham组、照射IR组、电离辐射联合铁死亡抑制剂处理Fer-1+IR组、电离辐射联合凋亡抑制剂处理Z-VAD+IR组、电离辐射联合自噬抑制剂处理CQ+IR组);用台盼蓝染色检测自噬基因敲低和过表达细胞模型以及雌激素受体抑制剂他莫昔芬(TAM)与电离辐射联合治疗下乳腺癌细胞的死亡率(他莫昔芬未处理TAM-组、他莫昔芬处理TAM+组)。结果 在8 Gy X射线照射后24 h处理条件下,雌激素受体阳性乳腺癌ZR75细胞ESR1的敲低促进细胞死亡(t=3.49、3.13, P < 0.05),而雌激素受体阴性乳腺癌MDA-MB-231细胞ESR1的过表达抑制细胞死亡(t=4.16、7.48, P < 0.05);与单纯照射相比,自噬抑制剂氯喹的处理后增加了敲低ESR1的ZR75细胞集落形成数量(t=8.49, P < 0.05), 抑制自噬可以减少沉默ESR1所致的ZR75细胞死亡。在电离辐射处理下,MDA-MB-231细胞过表达ESR1促进了细胞保护性自噬;ZR75细胞敲低ESR1后细胞保护性自噬降低。在ZR75细胞中敲低ATG5发现自噬降低,细胞死亡增加(t=4.19、6.39, P < 0.05),而在ZR75中过表达ATG5可以逆转因敲低ESR1导致的细胞死亡增加(t=1.70、4.65, P < 0.05)。化疗药物他莫昔芬处理雌激素受体阳性乳腺癌细胞ZR75后发现自噬基因ATG5、ATG12的表达下降,自噬抑制,细胞死亡增加(t=18.70, P < 0.05),电离辐射处理促进了这一进程(t=16.82, P < 0.05)。结论 雌激素受体ESR1通过增加ATG5自噬相关蛋白,促进雌激素受体阳性乳腺癌细胞的保护性自噬,从而导致雌激素受体阳性乳腺癌细胞的辐射抵抗,化疗药物他莫昔芬联合电离辐射治疗增加了雌激素受体阳性乳腺癌细胞的辐射敏感性。     

ATM,radiation, and the risk of second primary breast cancer

Abstract

Purpose: It was first suggested more than 40 years ago that heterozygous carriers for the human autosomal recessive disorder Ataxia-Telangiectasia (A-T) might also be at increased risk for cancer. Subsequent studies have identified the responsible gene, Ataxia-Telangiectasia Mutated (ATM), characterized genetic variation at this locus in A-T and a variety of different cancers, and described the functions of the ATM protein with regard to cellular DNA damage responses. However, an overall model of how ATM contributes to cancer risk, and in particular, the role of DNA damage in this process, remains lacking. This review considers these questions in the context of contralateral breast cancer (CBC).

Conclusions: Heterozygous carriers of loss of function mutations in ATM that are A-T causing, are at increased risk of breast cancer. However, examination of a range of genetic variants, both rare and common, across multiple cancers, suggests that ATM may have additional effects on cancer risk that are allele-dependent. In the case of CBC, selected common alleles at ATM are associated with a reduced incidence of CBC, while other rare and predicted deleterious variants may act jointly with radiation exposure to increase risk. Further studies that characterize germline and somatic ATM mutations in breast cancer and relate the detected genetic changes to functional outcomes, particularly with regard to radiation responses, are needed to gain a complete picture of the complex relationship between ATM, radiation and breast cancer.     

Risk analysis of electronic intraoperative radiation therapy for breast cancer

PurposeTo evaluate the process and improve safety of intraoperative radiation therapy (IORT) for early-stage breast cancers treated with electronic brachytherapy.Methods and MaterialsA multidisciplinary team conducted a failure mode and effects analysis (FMEA) for IORT breast cancer treatments by first developing a process map. This map was then used to identify failure modes for all steps in the treatment workflow. Risk priority numbers (RPNs) were assigned to each failure mode and were calculated as the product of the failure mode's probability of occurrence (O), severity (S), and lack of detectability (D). Corrective steps were implemented to address failure modes with the highest risk, and a revised process was generated.ResultsThe steps with the highest risk failure modes were related to source calibration, use of correct plan and dwell times, and the correct site and intent. The introduction of a physician calibration check and an extended time-out checklist reduced the risk of these failure modes. The highest risk steps in the Xoft breast IORT treatment process are associated with source calibration and manual entry of dwell positions for each balloon size and volume combination. High-risk failure modes that could be mitigated with improved hardware and software interlocks were identified.ConclusionHigh-risk failure modes are identified with FMEA and addressed with corrective steps. This application of FMEA can be used in principle for clinical processes throughout breast cancer care. This analysis demonstrates the importance of well-designed QC policies, procedures, and oversight in a Xoft electronic brachytherapy program for breast cancer IORT.     

Adaptive radiation therapy of breast cancer by repeated imaging during irradiation

Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide. A multimodality treatment approach may be utilized for optimal management of patients with combinations of surgery, radiation therapy (RT) and systemic treatment. RT composes an integral part of breast conserving treatment, and is typically used after breast conserving surgery to improve local control. Recent years have witnessed significant improvements in the discipline of radiation oncology which allow for more focused and precise treatment delivery. Adaptive radiation therapy (ART) is among the most important RT techniques which may be utilized for redesigning of treatment plans to account for dynamic changes in tumor size and anatomy during the course of irradiation. In the context of breast cancer, ART may serve as an excellent tool for patients receiving breast irradiation followed by a sequential boost to the tumor bed. Primary benefits of ART include more precise boost localization and potential for improved normal tissue sparing with adapted boost target volumes particularly in the setting of seroma reduction during the course of irradiation. Herein, we provide a concise review of ART for breast cancer in light of the literature.     

电离辐射联合肿瘤坏死因子相关凋亡诱导配体对乳腺癌MCF-7细胞株作用的研究

目的 探讨肿瘤坏死因子相关凋亡诱导配体（TRAIL）对人乳腺癌MCF．7细胞株的作用以及与放射治疗联合的可行性。方法1×10^4／ml MCF-7细胞接种至96孔板培养后加入不同浓度的TRAIL、给予不同剂量照射及TRAIL与电离辐射联合，Mrrr法检测细胞抑制率。MCF-7细胞接种至6孔板培养后，分别加入TRAIL（1μg／ml）、给予8Gy照射及TRAIL与8Gy照射联合，流式细胞术检测不同处理组细胞的凋亡率。应用RT-PCR法检测经不同处理后的细胞凋亡相关基因的表达情况。结果TRAIL（1μg／ml）与4、8和12Gy照射联合后对细胞的抑制率明显增加，与单独应用TRAIL及单独照射相比，差异有统计学意义。RT-PCR结果显示Bcl-2、Bcl-Xl基因在TRAIL与8Gy照射联合时表达减弱。结论在体外实验中，乳腺癌MCF-7细胞株对TRAIL不敏感，但TRAIL与电离辐射照射联合后抗肿瘤作用增强，TRAIL可能是一种有临床应用潜能的新型抗肿瘤生物制剂。     

低剂量辐射对CIK细胞杀伤乳腺癌细胞作用的影响

目的 研究低剂量辐射对CIK细胞杀伤乳腺癌细胞MCF-7和SK-BR-3作用的影响,探讨其可能的作用机制。方法 取健康人外周血浓缩白细胞,常规分离出单个核细胞,加入不同的细胞因子培养7 d,诱导DC与CIK细胞,并将其按1 :5的比例共同培养7 d获得DC-CIK细胞。DC-CIK及CIK细胞分别给予40、80、120 mGy X射线照射,流式细胞仪检测细胞表型变化,运用CCK-8的方法检测其对乳腺癌细胞的杀伤作用。结果 DC-CIK组对乳腺癌细胞SK-BR-3较CIK组在不同效靶比均有更强的杀伤活性(t=3.63、5.62、8.21、5.49,P<0.05)。与CIK 0 mGy组相比,CIK细胞联合40、80、120 mGy低剂量辐射对乳腺癌细胞MCF-7和SK-BR-3的杀伤活性明显增高,而DC-CIK细胞联合低剂量辐射组与DC-CIK 0 mGy组相比,差异无统计学意义。结论 低剂量辐射对CIK细胞杀伤乳腺癌细胞有协同作用。     

Therapeutic potential of melatonin for breast cancer radiation therapy patients

Melatonin is an endogenous hormone primarily known for its action on the circadian rhythms. But pre-clinical studies are reporting both its radioprotective and radiosensitizing properties, possibly mediated through an interaction between melatonin and the regulation of estrogens. Melatonin pre-treatment prior to ionizing radiation was associated with a decrease in cell proliferation and an increase in p53 mRNA expression, leading to an increase in the radiosensitivity of breast cancer cells. At the same time, a decrease in radiation-induced side effects was described in breast cancer patients and in rodent models. This review examines the potential for melatonin to improve the therapeutic outcomes of breast radiation therapy, specifically estrogen receptor positive patients. Evidence suggests that melatonin may offer a novel, non-toxic and cheap adjuvant therapy to improve the existing treatment modalities. But further research is required in the clinical setting before a clear understanding of its therapeutic benefits is determined.     

催乳素水平与女性绝经前后乳腺癌的相关性研究

目的研究血清催乳素(prolactin,PRL)水平与女性绝经前后发生乳腺癌的关系。方法选取在我院手术治疗的乳腺癌96例及乳腺良性增生144例,将其分为绝经前乳腺癌组(RⅠ组,48例)、绝经后乳腺癌组(RⅡ组,48例)、绝经前乳腺良性增生组(ZⅠ组,88例)与绝经后乳腺良性增生组(ZⅡ组,56例)。采用电化学发光法检测患者外周静脉血血清的催乳素水平。结果RⅠ组催乳素水平明显增高,与RⅡ组及ZⅠ组比较差异均有统计学意义(P＜0001)。RⅠ组催乳素阳性率均高于RⅡ组、ZⅠ组,且差异均有统计学意义(P＜0001);RⅡ组与ZⅡ组间阳性率比较差异无统计学意义（P=0776）。PRL检测在女性绝经前乳腺癌和绝经后乳腺癌对比中,敏感性（P＜0001）及准确性（P=0003）均高。结论催乳素在女性绝经前乳腺癌发生、发展中有一定意义,检测催乳素有助于乳腺癌的早期诊断与预防。     

乳腺癌X线毛刺征的病理学基础探讨

目的：探讨乳腺癌X线毛刺征形态学特点及其病理学基础。方法：回顾性分析51例具毛刺征的乳腺癌X线和病理学表现。所有病例均具备完整的X线摄片和病理切片资料。结果：X线上乳腺癌肿块具备长毛刺征6例，短毛刺征30例，星状影15例。病理学上，肿块毛刺成分均匀者23例．不均匀13例；而星状影则为5例、10例；肿块周边胶原纤维活性按低到中度和高度划分，长毛刺征为6例、0例，短毛刺组征为24例、6例，星状影为12例、3例；肿块周边呈浸润扩散改变，长毛刺征3例(50%)，短毛刺征27例(90%)，星状影12例(80％)。毛刺内伴钙化12例，均在癌浸润扩散基础上发生。结论：乳腺癌肿块边缘，癌浸润扩散是X线上毛刺征形成的主要病理学基础。毛刺内伴钙化是乳腺癌重要的恶性X线征象。     

Mammographic and ultrasonographic findings in bilateral breast cancer: a comparative study

To compare the results of mammographic and US examinations in unilateral and bilateral breast cancers in routine clinical work, the files of all patients with 825 preoperative mammograms and 525 preoperative US examinations operated on for primary breast cancer in the Oulu University Hospital from 1983 through 1993 were retrospectively reviewed. The only statistically significant difference noted in the mammographic findings was the false-negative rates in unilateral, bilateral and metachronous second breast cancers (6.8, 16.3 and 23.3 %, respectively). The differences were mainly due to the lower sensitivity of mammography in the detection of palpable bilateral breast cancers. The false-negative rate of US was also significantly higher in bilateral breast cancers (23 %) than in unilateral cancers (11 %), and significantly higher for nonpalpable than palpable cancers in both the bilateral and the unilateral groups. The mammographic failure rates and the difference between these two groups were most pronounced during the early study period, which underscores the importance of experience and dedicated imaging technique. The smaller tumour size at the time of diagnosis and probably the loss of the opposite breast for comparison have contributed to the higher false-negative rates in bilateral breast cancer. Received 25 April 1997; Revision received 1 September 1997; Accepted 6 October 1997     

早期乳腺癌保乳术后仰卧及俯卧位调强放疗的剂量学比较

目的 比较早期乳腺癌保乳术后仰卧位与俯卧位调强治疗计划靶区和危及器官的剂量学差异.方法 选取15例接受保乳术后放疗的大乳腺及乳腺下垂的左侧乳腺癌患者,分别进行仰卧位及俯卧位CT定位扫描,利用相同优化条件分别进行切线2野调强治疗计划设计.比较2种不同体位计划的靶区剂量分布、心脏、左肺及右侧乳腺受照剂量和体积,以及机器跳数的差异.结果 俯卧位调强计划适形度指数(CI)优于仰卧位计划(0.79±0.05 vs. 0.72±0.04,W=138,P<0.01),均匀性指数(HI)也优于仰卧位计划(1.09±0.01 vs. 1.12±0.02,t=-4.7,P<0.01).俯卧位计划靶区接受95%处方剂量照射的百分体积(V_95%)、最小剂量(D_min)大于仰卧位计划(t=7.1、6.4,P<0.01),平均剂量(D_mean)大于仰卧位计划(W=153,P<0.01),最大剂量(D_max)小于仰卧位计划(t=-3.6,P<0.01).仰卧位计划的右乳接受5 Gy照射的百分体积(V₅)小于俯卧位计划(W=160,P<0.01),心脏接受30 Gy照射的百分体积(V₃₀)大于俯卧位计划(t=5.4,P<0.01),心脏平均剂量(D_mean)、左肺接受20和5 Gy照射的百分体积(V₂₀、V₅)明显大于俯卧位计划(W=133、120、120,P<0.01).机器跳数间差异无统计学意义.结论 对于大乳腺及乳腺下垂乳腺癌患者,保乳术后俯卧位调强计划与仰卧位调强计划相比,靶区剂量分布更均匀,心、肺受照射剂量和体积明显减少.     

保乳术后固定野动态调强与容积调强放疗的剂量学比较

目的 比较早期乳腺癌保乳术后固定野动态调强与容积调强放疗治疗靶区和危及器官的剂量学差异.方法 20例左侧乳腺癌患者(均女性,24～75岁)保乳术后接受放疗,在同一患者CT影像上分别进行2野共面动态调强和容积调强(RapidArc)两种治疗计划设计.在剂量-体积直方图中读取两种计划的靶区剂量分布参数,心脏、双侧肺及对侧乳腺受照剂量和体积,对各参数的均数进行比较;并比较两者平均机器跳数和平均治疗时间的差异.结果 RapidArc较IMRT计划CTV V95%增加了0.65%(t=5.16,P=0.001),V105%下降了10.96%(t=-2.05,P=0.055),V110%下降了1.48%(t=-1.33,P=0.197).RapidArc计划的适形指数(CI)和均匀性指数(HI)均优于IMRT治疗计划,分别为0.88±0.02 vs 0.74±0.03(t=18.54,P＜0.001),1.11±0.01 Vs 1.12±0.02(t=-2.44,P=0.025).两种计划中左肺V20和Dmax比较差异无统计学意义,但在RapidArc计划中V10、V5、Dmix、Dmean明显增高,V5增高了接近30%.心脏V30和Dmax在两计划中无明显差异,而RapidArc计划的V10增加了18%,V5增加50%.RapidArc计划的右乳V5和右肺V5较IMRT分别增加了9.33%(t=9.31,P＜0.001)和3.04%(t=5.64,P＜0.001).RapidArc和IMRT平均机器跳数分别是608和437 MU(t=10.86,P＜0.001),平均治疗时间111.3和103.6 s(t=3.57,P=0.002).结论 早期乳腺癌保乳术后全乳腺RapidAre放疗与2野动态调强放疗相比,能明显改善靶区剂量分布均匀性.对于危及器官,高剂量区两种治疗计划之间无明显差异,低剂量区RapidArc的照射范围明显增加.与2野动态调强相比,RapidArc放疗机器跳数增加,治疗时间延长.

Abstract：

Objective To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery.Methods Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery.After target definition,treatment planning was performed by RapidAre and two fixed fields dynamic IMRT respectively on the same CT scan.The target dose distribution,homogeneity of the breast,and the irradiation dose and volume for the lungs,heart,and eontralateral breast were read in the dosevolume histogram (DVH) and compared between RapidAre and IMRT.The treatment delivery time and monitor units were also compared.Results In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV) ,the volume proportion of 95% prescribed dose (V95%) was significantly higher by 0.65% in RapidAre (t =5.16,P = 0.001) ,and the V105% and V110% were lower by 10.96% and 1.48 % respectively,however,without statistical significance (t =-2.05 ,P =0.055 and t =-1.33 ,P =0.197).The conformal index of planning target volume (PTV) by the Rap~dAre planning was (0.88±0.02),significantly higher than that by the IMRT planning [(0.74±0.03),t = 18.54,P < 0.001].The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01,significantly lower than that by the IMRT planning (1.12±0.02,t =-2.44,P =0.02).There were no significant differences in the maximum dose (Dmax) and V20 for the ipsilateral lung between the RapidArc and IMRT planning,but the values of V10,V5 ,Dmin and Dmean by RapidArc planning were all significantly higher than those by the IMRT planning (all P < 0.01).The values of max dose and V30 for the heart were similar by both techniques,but the values of V10 and V5 by the RapidArc planning were significantly higher (by 18% and 50% ,respectively).The V5 of the contralateral breast and lung by the RapidArc planning were increased by 9.33% and 3.04% respectively compared to the IMRT planning.The mean MU of the RapidArc was 608 MU,significantly higher than that by the IMRT planning (437 MU,t = 10.86,P < 0.001).The treatment time by the RapidArc planning was 111.3 s,significantly longer than that by IMRT planning (103.6 s,t = 3.57,P = 0.002).Conclusions The RapidArc planning improves the dose distribution of CTV and homogeneity of PTV for breast cancer radiotherapy after breast-conserving surgery.However,it significantly enlarges the volume of normal tissues irradiated in low dose areas,prolongs the treatment delivery time,and increases the MU value in comparison with IMRT.     

Offline adaptive radiation therapy in the treatment of prostate cancer: a case study

The purpose of this case study is to develop a method to account for the difference in the daily volumes in the bladder, rectum, and targets in prostate radiotherapy and to compare the predicted dose to the actual dose to these organs. Five patients, both prospectively and retrospectively, were selected from 2 different cancer centers, with a biopsy-confirmed diagnosis of prostate cancer. The patients' planning target volume (PTV) and organs at risk (OAR) were contoured on the computed tomography (CT) dataset using either Eclipse or Monaco treatment planning systems (TPSs). Cone-beam computed tomography (CBCT) scans were collected before each daily treatment and exported to MIM software for analysis. The automatically generated reports evaluated the organ volume changes, the actual dose received during a single fraction, and the projected dose to each organ at the completion of the treatment course via comparative cumulative dose-volume histograms (DVHs). Volume changes in the bladder and rectum can cause notable variations in the prescribed dose vs the actual dose received. MIM software was proven to have utility prospectively by tabulating daily dose and projecting final doses, potentially aiding physicians in decisions about the boost plans, thus making offline adaptive radiation therapy (ART) clinically manageable.     

146例女性乳腺癌危险因素的病例对照研究

应用1:1配比的病例对照研究方法对146例女性乳腺癌患者及其对照的危险因素进行了研究.分析结果表明:结婚年龄迟、初产年龄晚、有乳腺良性疾病史、有乳腺癌及其他恶性肿瘤家族史、月经周期不规律、腊肉香肠摄入量多、被动吸烟等因素可能为乳腺癌主要危险因素.而高产次、哺乳时间长、蔬菜摄入量多、服用维生素类药物等则可能是乳腺癌的保护因素.     

乳腺癌患者血清瘦素、可溶性瘦素受体及雌二醇测定的意义

目的 探讨测定乳腺癌患者血清瘦素（Lp）、可溶性瘦素受体（sLR）及雌二醇（E2）水平的临床意义。方法 分别用放射免疫分析法、化学发光免疫法、ELISA法测定55例乳腺癌患者血清Lp、E2和sLR水平，并同步测量体重指数（BMI），与20例良性乳腺疾病和20例健康体格检查者相应指标进行比较。结果 乳腺癌组血清Lp、BMI和E2水平明显高于健康对照组（P分别〈0．01、〈0．05），sLR水平与健康对照组相比呈下降趋势（P〈0．05）。Lp对乳腺癌的诊断灵敏度为47．27％（26／55例）、特异性为92．50％（37／40例）；E2对乳腺癌的诊断灵敏度为43．64％（24／55例）、特异性为97．50％（39／40例），而2项联合检查对乳腺癌的诊断灵敏度为69．09％（38／55例）、特异性为92．50％（37／40例）。结论 乳腺癌患者Lp和E2呈过表达现象。测定血清Lp、sLR及E2水平对研究乳腺癌的发生、发展及其诊断和探讨其与肥胖的关系都具有重要意义。     

Exploring correlations between the breast density of the women of Papua New Guinea and breast cancer risk factors

IntroductionPapua New Guinea (PNG), has experienced an increase in breast cancer incidence correlating to the westernisation of the country. Increased breast density is known to increase breast cancer risk. This study investigates if there are any factors unique to the women of PNG that may impact breast density and breast cancer risk.MethodA survey was undertaken of 1,161 women who had undergone mammographic imaging at the Pacific International Hospital (PIH). Results were correlated with the five Tabár mammographic parenchymal patterns (TP), recorded for each woman and geographical location, parity, breast size, occupation, marital and menstrual status, smoking and alcohol consumption, hormone replacement therapy (HRT), and exercise. Statistical analysis was undertaken using chi-square test, Fisher's exact test and Odds Ratio (OR).ResultsRelationships were identified between TP and parity (p < 0.001), marital status (p < 0.001), smoking (p < 0.001), alcohol intake (p = 0.029) and HRT (p = 0.029). There was no evidence of a relationship between pattern type and geographical location (p = 0.290), breast size (p = 0.592), occupation (p = 0.724), menstruation (p = 0.866) or exercise (p = 0.290). Married women, OR = 0.4004, CI 95% (0.2873–0.5579) and those with higher parity, OR 0.5034, CI 95% (0.3693–0.6862) were half as likely to have increased breast density reducing risk.ConclusionThere was no clear relationship across almost all data. Factors associated with increased breast density in PNG included parity, marital status, smoking, alcohol, and HRT use were evidenced in this snapshot of PNG women. Breast cancer risk was shown to be reduced for married women and those with increased parity.     

PET with [18F]fluorothymidine for imaging of primary breast cancer: a pilot study

The aim of this study was to evaluate the use of [¹⁸F]fluorothymidine (FLT) as a positron emission tomography (PET) tracer for the diagnosis of breast cancer. To this end, 12 patients with 14 primary breast cancer lesions (T2–T4) were studied by FLT-PET. For comparison, [¹⁸F]fluorodeoxyglucose (FDG) PET scans were performed in six patients. Thirteen of the 14 primary tumours demonstrated focally increased FLT uptake (SUV_mean=3.4±1.1). Seven out of eight patients with histologically proven axillary lymph node metastases showed focally increased FLT uptake in the corresponding areas (SUV_mean=2.4±1.2). The lowest SUV (mean =0.7) was observed in one of two inflammatory cancers. The contrast between primary tumours or metastases and surrounding tissue was high in most cases. In direct comparison to FDG-PET, the SUVs of primary tumours (5/6) and axillary lymph node metastases (3/4) were lower in FLT-PET (SUV_FLT: 3.2 vs SUV_FDG: 4.7 in primary tumours and SUV_FLT: 2.9 vs SUV_FDG: 4.6 in lymph node metastases). Since FLT uptake in surrounding breast tissue was also lower, tumour contrast was comparable to that with FDG. It is of note that normal FLT uptake was very low in the mediastinum, resulting in a higher tumour-to-mediastinum ratio as compared to FDG (P=0.03). FLT-PET is suitable for the diagnosis of primary breast cancer and locoregional metastases. High image contrast may facilitate the detection of small foci, especially in the mediastinum.