The reported cardiac effects are consistent with anthracycline-related cardiotoxicity. AT is associated with a cardiac risk similar to that of A monotherapy up to a cumulative A dose of 340-380 mg/m2.

PURPOSE Estrogen receptor (ER) and progesterone receptor (PR) status is prognostic and predictive in breast cancer. Because metastatic breast tumor biopsies are not routinely feasible, circulating tumor cells (CTCs) offer an alternative source of determining ER/PR tumor status. METHODS/PATIENTS Peripheral blood was collected prospectively from 36 patients with metastatic breast cancer. CTCs were isolated using the microfluidic OncoCEE™ platform. Detection was accomplished with an expanded anti-cytokeratin (CK) cocktail mixture and anti-CD45. ER/PR protein expression was assessed by immunocytochemistry (ICC) on the CK+ cells and compared to the primary and/or metastatic tumor (immunohistochemistry: IHC). RESULTS Among the 24 CK+ CTC cases, a concordance of 68% (15/22) in ER/PR status between primary breast tumor and CTCs and 83% (10/12) between metastatic tumor and CTCs was observed. An overall concordance of 79% (19/24) was achieved when assessing CTC and metastatic tumor (primary tumor substituted if metastatic breast biopsy not available). A test sensitivity of 72% and specificity of 100% was identified when comparing CTCs to tumor tissue. Of the 7 discordant cases between CTCs and primary tumor tissue, 2 were concordant with the metastatic biopsy. CONCLUSIONS CTC ER/PR status using the OncoCEE™ platform is feasible, with high concordance in ER/PR status between tumor tissue (IHC) and CTCs (ICC). The prognostic and predictive significance of CTC ER/PR protein expression needs further evaluation in larger trials.

III.

We have carried out a receiver operating characteristics (ROC) study for the enhancement of mammographic features in digitized mammograms. The study evaluated the benefits of multi-scale enhancement methods in terms of diagnostic performance of radiologists. The enhancement protocol relied on multi-scale expansions and non-linear enhancement functions. Dyadic spline wavelet functions (first derivative of a cubic spline) were used together with a sigmoidal non-linear enhancement function1' 2 We designed a computer interface on a softcopy display and performed an ROC study with three radiologists, who specialized in mammography. Clinical cases were obtained from a national mammography database of digitized radiographs prepared by the University of South Florida (USF) and Harvard Medical School. Our study focused on dense mammograms, i.e. mammograms of density 3 and 4 on the American College of Radiology (ACR) breast density rating, which are the most difficult cases in screening, were selected. To compare the performance of radiologists with and without using multi-scale enhancement, two groups of 30 cases each were diagnosed. Each group contained 15 cases of cancerous and 15 cases of normal mammograms. Conventional ROC analysis was applied, and the resulting ROC curves indicated improved diagnostic performance when radiologists used multi-scale non-linear enhancement.

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