Biomedical subjects

Yoshifumi Komoike

Publications and source records attributed to Yoshifumi Komoike.

At least 19 recordsLinked to original sources

PubMed2006

Three-axillary lymph node sampling for the prediction of nonsentinel node metastases in breast cancer patients with sentinel node metastases.

BACKGROUND: In half of breast cancer patients with positive sentinel nodes, the sentinel nodes are the only metastatic nodes. Such patients have no more metastatic nonsentinel nodes and do not need to undergo axillary lymph node dissection. The purpose of this study was to investigate whether three-axillary lymph node sampling after sentinel node biopsy predicts the status of nonsentinel nodes in patients with sentinel node metastases. METHODS: Sentinel node biopsy was performed with dye and radioisotope. When the sentinel nodes were diagnosed as metastasis positive by using intraoperative imprint cytology, three-axillary lymph node sampling was performed, followed by axillary lymph node dissection. RESULTS: Of 47 cases with positive imprint cytology, 43 (91%) were diagnosed as metastasis positive on their final histological examination and were analyzed. The status of the sampled nodes was significantly associated with the status of nonsentinel nodes (P < .0001). Six (43%) of 14 patients with positive sampled nodes had at least 1 positive remaining node. Only 2 (7%) of 29 patients whose sampled nodes were negative were found to have additional nodal metastases. The sensitivity, specificity, and accuracy of the sampled nodes for the prediction of nonsentinel node metastases were 87.5%, 100%, and 95.3%, respectively. CONCLUSIONS: We demonstrated that three-node sampling may be useful for predicting the status of nonsentinel nodes and avoiding axillary lymph node dissection in patients with only sentinel node metastases.

Adult↗

PubMed2006

Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases.

BACKGROUND: The clinical features of ipsilateral breast tumor recurrence (IBTR) after breast conserving therapy (BCT) for early stage breast cancer were analyzed from long-term follow-up of BCT in Japan. The purpose of this study was to clarify risk factors of IBTR and the impact of IBTR on development of distant metastases in this ethnic group. METHODS: Patients (N = 1901)with unilateral breast cancer < or = 3 cm in diameter who underwent BCT at 18 Japanese major breast cancer treatment institutes from 1986 to 1993 were registered in this study. Survival rates, the incidences of IBTR and distant metastases, and annual rates of IBTR and distant metastases after primary operation were calculated by the Kaplan-Meier method. A Cox proportional hazards model was used to estimate the risks of IBTR and distant metastases. A Cox model was also used to estimate the risks of distant metastases after IBTR in the group of IBTR. RESULTS: At a median follow-up time of 107 months, the 10-year overall and disease-free survival rates were 83.9% and 77.8%, respectively. The 10-year cumulative rates of IBTR were 8.5% in the patients with postoperative irradiation and 17.2% in the patients without irradiation. The 10-year cumulative distant metastasis rate was 10.9%. On multivariate analysis, young age, positive surgical margin, and omission of radiation therapy were significant predictors of IBTR. In addition, IBTR significantly correlated with subsequent distant metastases (hazard ratio, 3.93; 95% confidence interval, 2.676-5.771; P < 0.0001). Among patients who developed IBTR, initial lymph node metastases and short interval to IBTR were significant risk factors for subsequent distant metastasis. CONCLUSIONS: Young age, positive surgical margin, and omission of radiation therapy seemed to be important factors in relation to local control. The authors' results also indicated that IBTR is significantly associated with subsequent distant metastasis. Patients with positive nodal status at primary operation or with short interval from primary operation to IBTR are at especially high risk of distant metastasis. It remains unclear, however, whether IBTR is an indicator or a cause of subsequent distant metastases.

Adult↗

PubMed2006

Axillary recurrence after negative sentinel node biopsy in a patient with breast cancer: report of a case.

We report a case of axillary recurrence after sentinel node biopsy without axillary lymph node dissection in a patient with breast cancer. A hot and dye-stained node was identified at the primary operation and then at the time of axillary recurrence. Sentinel node biopsy is a promising alternative to axillary lymph node dissection in patients with breast cancer because of the low associated incidence of axillary recurrence.

Axilla↗

PubMed2006

Function-preserving surgery for breast cancer.

Breast-conserving treatment is well established as a safe method of treatment for the majority of breast cancers. Issues to be addressed concerning breast-conserving treatment include the omission of radiation therapy in low-risk patients, optimal local and systemic treatment for ipsilateral breast tumor recurrence, classification of ipsilateral breast tumor recurrence into true recurrences and new primary cancers, and the selection of patients who are eligible for breast conservation after neoadjuvant chemotherapy. There is much evidence that sentinel node biopsy is an accurate method of screening for axillary nodal status in patients with early breast cancer. Clearly, the avoidance of axillary dissection improves quality of life. The feasibility, accuracy, and timing of sentinel node biopsy in patients undergoing neoadjuvant chemotherapy are not yet clear. Also, the clinical significance of micrometastasis should be evaluated to determine the optimal application of sentinel node biopsy. There is interest in replacing breast-conserving treatment by nonsurgical ablation, although additional findings are needed to show that this technique is a true advance in breast cancer treatment.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

Immunohistochemical evaluation for hormone receptors in breast cancer: a practically useful evaluation system and handling protocol.

This article reviews the current status of hormone receptor evaluation in and out of Japan, and introduces the proposed working protocol of the task force for Adequate immunohistochemical evaluation in routine practice for breast cancer by the Japanese Breast Cancer Society. Understanding the principles and the developmental process of immunohistochemistry helps us to utilize a scoring system adequately. Methodologies of hormone receptor examination and immunohistochemical procedures are briefly introduced. Each scoring system is based on different principles. The proposed working protocol takes into account the reproducibility of results among observers, institutions and staining procedures, which is justified based on the current situation in Japan. Future directions for the standardization of immunohistochemical hormone receptor evaluation are also described.

Breast Neoplasms↗

PubMed2006

[Sentinel node biopsy in breast cancer].

Sentinel node biopsy is a new promising technique in the treatment of breast cancer. This technique may be a less invasive, highly accurate alternative to axillary lymph node dissection. An increasing number of studies demonstrated the feasibility and accuracy of sentinel node biopsy. However, many problems remain to be answered and must be addressed before sentinel node biopsy becomes the standard of care for patients with breast cancer. We reviewed and discussed here the proof of the sentinel node concept and several problems of sentinel node biopsy; identification technique, preoperative, intraoperative and postoperative examination of sentinel node.

Breast Neoplasms↗

PubMed2005

Usefulness of a solid-state gamma camera for sentinel node identification in patients with breast cancer.

BACKGROUND: A solid-state gamma camera was recently developed. This tool may enable intra-operative imaging of sentinel nodes in breast cancer. The aim of the present study was to evaluate the usefulness of a solid-state gamma camera for the pre- and intra-operative identification of sentinel nodes in patients with breast cancer. METHODS: Breast cancer patients with clinically negative nodes underwent sentinel node biopsy using dye and radioisotopes. Lymphoscintigraphy using both the conventional Anger camera and the solid-state gamma camera was performed the day before surgery. Sentinel nodes were intra-operatively identified using the gamma probe and imaged with a solid-state gamma camera, and then excised. When several sentinel nodes were present, these steps were repeated. RESULTS: Twenty-nine patients (30 basins) were enrolled in the study. The mean patient age was 54 years and the mean tumor size was 16 mm. A total of 41 sentinel nodes were identified using the Anger camera or the solid-state gamma camera pre-operatively. Thirty-eight sentinel nodes (92.7%) were identified using both the Anger camera and the solid-state gamma camera, 1 sentinel node (2.4%) was identified using the Anger camera alone, and 2 sentinel nodes (4.9%) were identified using the solid-state gamma camera alone. A total of 63 sentinel nodes were identified using the gamma probe or the solid-state gamma camera intra-operatively, and were excised. Fifty-seven sentinel nodes (90.5%) were identified using both the gamma probe and the solid-state gamma camera, 3 sentinel nodes (4.8%) were identified using the gamma probe alone, and 3 sentinel nodes (4.8%) were identified using the solid-state gamma camera alone. CONCLUSIONS: The solid-state gamma camera is useful for pre- and intra-operative identification of sentinel nodes in breast cancer. The significance of the solid-state gamma camera could be that it compensates for the gamma probe when the gamma probe cannot identify some sentinel nodes because of the shine through effect, and avoids leaving the residual sentinel nodes behind the axilla intra-operatively.

Adult↗

PubMed2005

Analysis of ipsilateral breast tumor recurrences after breast-conserving treatment based on the classification of true recurrences and new primary tumors.

BACKGROUND: Ipsilateral breast tumor recurrences (IBTR) after breast-conserving treatment include two different entities: true recurrence (TR) thought to occur when residual cancer cells grow gradually to detectable size and new primary (NP) thought to be de novo cancer independently arising in the preserved breast. The patients with ipsilateral breast tumor recurrence (IBTR) are potentially at high risk for subsequent distant metastasis, but many studies do not distinguish between these types of recurrence. The aim of this study is to clarify the biological difference between TR and NP, and to show the clinical significance of classifying IBTR into these two types of recurrence. PATIENTS AND METHODS: A total of 172 patients with IBTR after breast-conserving therapy from the cohort of a long-term large scale study (Research of cancer treatment from the Ministry of Health, Labor and Welfare of Japan (no.13-9)) were analyzed. We classified IBTRs as TR or NP based on tumor location and pathological findings. The characteristics of the primary tumors of TR and NP were compared. Survival rates and risk factors of each type of IBTR were examined by the Kaplan-Meier method. The results of salvage surgery were also analyzed. RESULTS: Of the 172 patients, 135 patients were classified as TR and 26 as NP. Eleven cases could not be categorized. The primary tumor of TR was characterized by a high rate of lymph node metastasis (37.8%) and short disease-free interval (mean DFI; 46.6 months) while that of NP showed a rather low lymph node positivity (8.7%) and longer DFI (62.1 months). The risk factors for TR were young age, positive surgical margin, omission of irradiation and positive lymph node metastasis. Those for NP were young age, omission of irradiation and contralateral breast cancer after the primary operation. The 5-year survival rates after IBTR were 71.0% in TR and 94.7% in NP (p=0.022). Salvage operation was performed in 136 IBTRs. Eighty-one patients underwent salvage mastectomy and 55 patients underwent repeat lumpectomy. Five-year survival rates after salvage operation were 75.7% for mastectomy and 84.2% for lumpectomy (N.S.). Twenty percent of patients who underwent repeat lumpectomy developed secondary local relapse within 5 years after salvage treatment. The risk factors for secondary local relapse were analyzed. Limited to cases of IBTR which received radiation therapy after the primary operation, NP was the only factor influencing secondary local relapse by univariate analysis. CONCLUSIONS: TR and NP show clinically quite different features; time to occurrence, characteristics of the original tumor, prognosis and risk factor profile for IBTR were all different. Classifying IBTR as TR or NP can provide clinically significant data for the management of IBTR.

Adult↗

PubMed2005

A case of phyllodes tumor of the breast with a lesion mimicking fibroadenoma.

We report a case of phyllodes tumor (PT) with multiple lesions partly mimicking fibroadenoma (FA). A 43-year-old woman was referred to our institute because of a left breast mass which was diagnosed as FA clinically. During the follow-up, the mass gradually enlarged and excisional biopsy was performed to rule out malignant lesion. On histological examination, the tumor consisted of three different components; a lesion diagnosed as FA, another lesion as benign PT, and the other lesion as borderline PT. Finally, the tumor was diagnosed as borderline PT. Stromal cellularity may vary from area to area in any given PT. If there are some disagreements among the findings of imagings and cytology for the diagnosis of FA, as was seen in our case, the possibility of coexistence of PT should be considered.

Adult↗

PubMed2004

Controversies in sentinel node biopsy for breast cancer.

Sentinel node biopsy for breast cancer patients has recently been applied as a less invasive, highly accurate alternative to axillary lymph node dissection. Numerous studies have shown that sentinel nodes accurately diagnose axillary staging. However, many problems remain to be answered and must be addressed before sentinel node biopsy becomes the standard surgical procedure for patients with breast cancer. We reviewed and discussed here three of these problems; axillary sampling as an alternative to sentinel node biopsy, dye method vs. combination of dye and radiocolloid for sentinel node biopsy, and intraoperative sentinel node examination. Further investigation will continue to be necessary as we learn how to better provide procedure of sentinel node biopsy.

Axilla↗

PubMed2004

A case of invasive lobular carcinoma of the breast first manifesting with duodenal obstruction.

Lobular carcinoma of the breast presents with various clinical manifestations. Lobular carcinoma comprises about one fifth of cases of ductal carcinoma. Intestinal metastasis is dominant in cases of lobular carcinoma. Without a prior diagnosis of lobular carcinoma of the breast, the diagnosis of intestinal metastasis from breast cancer is difficult. A 52-year-old women underwent duodenogastrectomy for duodenal cancer. About 18 months later, she underwent mastectomy for lobular carcinoma of the breast. The duodenal cancer consisted mainly of malignant cells invading the submucosa that were identical to those in the breast. Immunohistochemical assays for estrogen receptor also confirmed breast cancer metastasis. Duodenal obstruction was the first sign of isolated metastatic lobular carcinoma of the breast in this case. The characteristic metastatic pattern of lobular carcinoma, which differs from that of ductal carcinoma, should be kept in mind to ensue proper diagnosis. Preceding breast surgery for lobular carcinoma should prompt investigation based on the typical metastatic pattern.

Breast Neoplasms↗

PubMed2004

[Controversies in breast conservation treatment for breast cancer].

Breast conservation treatment has become the standard treatment for early breast cancer patients, after the equivalence of mastectomy and breast conservation treatment was demonstrated in prospective, randomized trials and large retrospective studies. New questions, such as the feasibility of neoadjuvant chemotherapy in improving breast conserving rate, the appropriateness of breast conservation treatment in ductal carcinoma in situ, the effectiveness of radiation therapy in patients treated by breast conservation, and patient selection for breast conservation without radiation, are now being raised. Future work that needs to be done to answer these questions is discussed in this review.

Breast Neoplasms↗

PubMed2003

Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patients.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate whether the intradermal injection of radiocolloids would improve the identification rate of sentinel nodes over the subdermal injection in breast cancer patients. METHODS: Sentinel node biopsy was performed in T2 breast cancer patients with clinically negative nodes, using subdermal or intradermal injection of radioisotopes with the peritumoral dye injection. We used Tc-99m tin colloid, with a larger particle size (0.4-5 microm), rather than sulfur colloid and colloidal albumin. RESULTS: The initial 55 patients underwent subdermal injection of radiocolloids; the next 61 patients underwent intradermal injection of radiocolloids for sentinel node biopsy. The detection rate of sentinel nodes was significantly (P = 0.048) higher in the intradermal injection group (61/61, 100%) than in the subdermal injection group (51/55, 92.7%). False-negative rates were comparable between the two groups. Lymphoscintigraphy visualized the sentinel nodes significantly (P < 0.0001) more often in the intradermal injection group (59/61, 96.7%) than in the subdermal injection group (20/54, 37.0%). CONCLUSIONS: A significantly higher identification rate of sentinel node biopsy and lymphoscintigraphy can be achieved by intradermal injection of Tc-99m tin colloid with a large particle size than by subdermal injection.

Axilla↗

PubMed2003

Repeat lumpectomy for patients with ipsilateral breast tumor recurrence after breast-conserving surgery. Preliminary results.

In this study, we assessed the appropriateness of conducting repeat lumpectomy for ipsilateral breast tumor recurrence (IBTR) based on the characteristics of recurrence after primary breast conserving surgery (BCS). Of 41 patients who had developed IBTR from October 1986 to June 2000 at our institute, 11 underwent mastectomy of the remaining breast and 30 underwent repeat lumpectomy. The 5-year overall survival rate at a median follow-up of 43 months after salvage surgery was 90.9% for the mastectomy group and 90.0% for the lumpectomy group. The 5-year distant disease-free survival rate was 70.1% for the mastectomy group and 83.0% for the lumpectomy group. The survival rates were remarkably high in both treatment groups, with no significant difference between them. IBTRs in the majority of our patients were small lesions less than 1 cm in diameter. They did not feature lymphatic invasion and had low histological grade. Compared with that of primary lesions, the malignancy of recurrent tumors was not increased in many patients. In contrast to these preferable features, 9 of 30 patients who underwent repeat lumpectomy developed second local relapse within 3 years after salvage operation. Young age (<or=35 years), positive family history and omission of adjuvant systemic therapy were found to exhibit trends as a discriminate for further local recurrences. In view of the relatively good prognosis of IBTRs and excellent results of repeat lumpectomy, we consider this method a treatment option that deserves serious consideration if we can select the patients who will not likely develop second local relapse.

Adult↗

PubMed2002

Breast-conserving treatment after neoadjuvant chemotherapy in large breast cancer.

Several recent trials have demonstrated that neoadjuvant chemotherapy can allow more patients to successfully undergo breast-conserving treatment (BCT), and does not confer a survival disadvantage compared with standard adjuvant chemotherapy. In addition, the pathological response of primary breast tumors to neoadjuvant chemotherapy appears to be a surrogate marker for patient outcome. In our series, during the period from May 1995 to December 2000, 86 patients with tumors between 3.1 and 6.0 cm in diameter received epirubicin-based neoadjuvant chemotherapy. There were 55 (64.0%) responders and ultimately 64 patients (74.4%) were treated with BCT. The margin positive rate was 14.1%(9/64), similar to the rate after BCT for early-stage breast cancers, the largest diameter of which was smaller than 3 cm. At a median follow-up of 30 months, only 3 patients in the BCT group have developed local recurrence; the local recurrence rate appears to be comparable to that after BCT for early stage breast cancers. Long term follow-up is required, however, to establish whether this procedure is a safe alternative to mastectomy for patients with large breast cancers.

Antineoplastic Agents↗

PubMed2002

Long-term results of breast conserving surgery for stages I and II breast cancer: experiences at Osaka Medical Center for Cancer and Cardiovascular Diseases.

PURPOSE: The purpose of this study is to summarize the long-term results of breast conserving surgery (BCS) for Japanese patients with stage I and II breast cancer at a single institute and to identify risk factors for local recurrence after BCS. PATIENTS AND METHODS: Between October 1986 and June 2000, 979 women underwent BCS with or without radiation therapy (RT). Overall survival, disease free survival and local recurrence rates were calculated by the Kaplan-Meier method. Risk factors for local recurrence were examined by multivariate analysis using the Cox proportional regression model. RESULTS: The 10-year overall survival rates were 90.9% for the surgery and radiation therapy (RT group) and 89.3% for the surgery only group with a median follow-up time of 46 months. The 10-year disease free survival rates were 85.1% in the RT group and 69.2% in the surgery only group (p=0.0001). The positive margin rate was 14.1% (138/979). The 10-year overall survival rate of the patients with positive margins was 87.9%, compared with 90.8% for patients with negative margins (N.S.). The cumulative incidence of local recurrence at 10 years was significantly lower in the RT group (7.2% ) than in the surgery only group (27.5% ) (p<0.0001). Multivariate analysis showed that positive margins and lack of post-operative irradiation or adjuvant endocrine therapy were risk factors for non-inflammatory local recurrence. CONCLUSIONS: Our study indicates that BCS can be performed for Japanese women with early breast cancer. The margin status and post-operative irradiation had no influence on overall survival while but were significantly related to local recurrence.

Adult↗

PubMed2002

Sentinel node biopsy to avoid axillary lymph node dissection in breast cancer.

The role of sentinel node biopsy in breast cancer has increased over the last few years. Sentinel nodes can predict the status of all axillary lymph nodes precisely and select patients with negative nodes for whom axillary dissection is unnecessary. Many problems remain, such as the ideal injection technique, ideal agents, and ideal histological detection of sentinel node metastases, and must be addressed before sentinel node biopsy becomes the standard of care for patients with breast cancer.

Axilla↗

PubMed2002

Patient age affects identification rate of sentinel nodes in breast cancer.

BACKGROUND: The aim of this study was to investigate whether clinicopathological features affect the success rate of identifying sentinel nodes using a combination method of dye and radioisotope in breast cancer patients. METHODS: Sentinel node biopsy was performed in patients (n = 154) with stage I and II breast cancer using a combination method. The association between the clinicopathological features of breast cancer and the success rate in the identification of sentinel nodes was investigated. RESULTS: Sentinel nodes were successfully identified in 147 (95.5%) of the 154 patients. There was a concordance between the sentinel-node and axillary-node status in 146 (99.3%) of 147 cases. The false negative rate of the sentinel node biopsy was 2.4% (1/42). The identification rate of sentinel nodes was significantly (P = 0.005) lower in patients > or = 60 years (84.4%) than in those < 60 years (98.4%). The tumor size, histological node status, lympo-vascular invasion, history of previous surgical biopsy, operative procedure, tumor location, and histological type were not related with the identification rate of sentinel nodes. The mean count ratio of all hot nodes was 14.0 (range 2.0-73.6) in patients > or = 60 years and 73.4 (2.0-1700.6) in patients < 60 years, and this difference was statistically significant (P < 0.0001). In addition, the mean number of sentinel nodes was significantly (P = 0.0006) lower in patients > or = 60 years (1.3; range one to four) than in patients < 60 years (2.1; range one to 12). CONCLUSIONS: Patient age affects the identification rate of sentinel nodes using a combination method in breast cancer.

Adult↗