This study aimed to investigate whether adipose tissue invasion (ATI) of cancer cells at the tumor margin influenced lymph node status and prognosis in patients with invasive ductal carcinoma of the breast. Data for 245 patients with breast cancer with marginal ATI were clinicopathologically compared with data for 65 patients without ATI. We also examined the value of the combination of ATI and peritumoral lymphatic vessel invasion (LVI). The frequency of axillary lymph node metastases was 40.7% in patients with ATI (99/243) and 11.3% in patients without ATI (7/62; P<.0001), and ATI was an independent factor influencing nodal metastasis. Patients with ATI had a poorer prognosis than patients without ATI (10-year disease-free survival, 76% and 94%, respectively; P=.0323). In addition, patients without ATI or LVI had neither lymph node metastasis (n=52) nor recurrent disease (n=53). ATI is one of the biologic indicators of tumor aggressiveness.

SUMMARYIt is clinically important to evaluate the severity of right ventricular (RV) overload in patients with chronic pulmonary diseases (CPD). For such evaluation, echocardiography has been widely used because the procedure is noninvasive and can be performed repeatedly. We evaluated the severity of RV overload in CPD patients to assess the usefulness of pulsed Doppler echocardiography. The A/E ratio and deceleration time of early RV inflow velocity correlated significantly with the mean pulmonary artery pressure (MPAP) both in patients with and without CPD. The acceleration time/RV ejection time (AcT/ RVET) was significantly lower in CPD patients than control subjects and correlated significantly with MPAP. Furthermore, AcT/RVET improved in patients with mild respiratory failure after oxygen therapy, along with a decrease in MPAP. We also compared the new index of myocardial performance (NI) in control subjects and patients with pulmonary tuberculosis sequelae (TB) undergoing home oxygen therapy. The NI was significantly higher in the TB group. Although these results were satisfactory, the pulsed Doppler echocardiography has certain disadvantages because monitoring is influenced by anatomical factors and it is difficult to perform in patients with atrial fibrillation or tachycardia. We conclude that echocardiography using a Doppler method is a useful noninvasive technique for assessment of the right heart system. The precision of this procedure can be improved by combination with other echocardiographic indices of RV overload. (Jpn Heart J 2001; 42: 483-493) Key words: Pulsed Doppler echocardiography, Peak atrial filling velocity/peak early diastolic filling velocity (A/E), Acceleration time/ejection time (AcT/ET), New index of myocardial performance, Chronic pulmonary disease PREVIOUS studies have demonstrated that the severity of right ventricular (RV) overload is an important prognostic factor in patients with chronic pulmonary disFrom

We evaluated right ventricular (RV) diastolic performance in 12 healthy subjects (control), 25 patients with chronic pulmonary diseases (CPD) and 6 patients with chronic pulmonary thromboembolism (PTE). Flow velocity patterns were determined by the pulsed Doppler technique. The values determined included acceleration time (AT), deceleration time (DT), and the ratio of the atrial contraction wave (A) to the rapid filling wave (R) (A/R ratio) from flow velocity patterns in the RV inflow tract. DT was significantly prolonged in the CPD and PTE groups compared with the control group, indicating dysfunction during the early (middle) filling period. The prolongation was marked in those patients with pulmonary hypertension. The A/R ratio was significantly higher in the CPD and PTE groups than in the control group, indicating a decrease in RV compliance. The A/R ratio increased slightly with the increase in the end-diastolic volume index. These results suggested that the pressure overload plays an important role in RV diastolic dysfunction in patients with pulmonary disease, and that preload contributes to the dysfunction.

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