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Background: It is well known that patients with triple-negative breast cancer (TNBC) have a high risk of local tumor recurrence in ipsilateral breast. To know the additional value of breast magnetic resonance imaging (MRI) in preoperative prediction of tumor extent for TNBC, we tested the accuracy of MRI in correlation with pathologic tumor size according to subtypes. In addition, we investigated the margin-positive rates by subtypes among the patients receiving breast-conservative surgery (BCS). Methods: We retrospectively identified patients with invasive breast cancer who had preoperative breast MRI and ultrasound between 2011 and 2014. We excluded patients having large tumor more than 5cm or multiple tumors. Patients were classified into 4 subtypes (luminal A, luminal B/HER2, HER2, triple-negative breast cancer (TNBC)) based on the immunohistochemistry. Lin's concordance correlation coefficient was used to measure the agreement between the MRI or ultrasound and tumor extent. Also, patients were classified into three groups according to the accuracy of MRI in correlation with tumor extent (concordance, underestimation, and overestimation). Tumor extent was defined as pathologic tumor size including in situ carcinoma. Results: In a total of 589 patients, 397(67.4%) women received BCS. Means of tumor size were 1.99 ± 0.91 cm by pathologic review, 1.91 ± 1.01 cm by MRI, and 1.76 ± 0.92 cm by ultrasonography, respectively. Correlation analysis revealed a similar concordance rate between MRI and ultrasound to pathologic tumor size (r= 0.622 and 0.573). Lin's concordance analysis showed that MRI showed more significant correlation with pathologic tumor size than ultrasound in patients with TNBC (r= 0.735 VS 0.593, p=0.0052). However, the proportion of concordant group did not differ significantly according to subtypes (p=0.279). Conclusions: Our findings suggest that preoperative MRI does not increase the accuracy in predicting tumor extent or reduce the margin-positive rates in breast cancer. Citation Format: Yang BS, Lee HW, Park JT, Lee HM, Ahn SG, Jeong J. Value of magnetic resonance imaging in preoperative predicting tumor extent in each subtypes of breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-11.

Background: Previous studies have shown that progesterone receptor (PR) status has a prognostic value in hormone receptor-positive breast cancer. In this study, we evaluated the clinical significance of PR status in estrogen receptor (ER)-positive and HER2-positive breast cancer. Methods: We retrospectively analyzed the data of ER+ and HER2+ breast cancer patients who underwent surgery at Gangnam Severance hospital and Severance hospital from 2002 to 2012. We excluded patients who had a history of previous cancer, received neoadjuvant chemotherapy, did not received adjuvant chemotherapy, and had contralateral breast cancer or metastasis at diagnosis. A total of 346 patients were identified. Among them, 155 patients (44.8%) received adjuvant trastuzumab. Results: At a median follow-up of 59 months, median disease-free survival (DFS) and overall survival (OS) were 56 and 59 months, respectively. The DFS and OS showed no difference according to PR status in overall patients. Then, these patients were categorized into two groups: ER+/HER2+/PR+ and ER+/HER2+/PR-. In ER+/HER2+PR+ patient, there was no difference of DFS or OS according to trastuzumab use. In ER+/HER2+/PR- patients, DFS was significantly better in patients who received adjuvant trastuzumab treatment compared to those who did not (p=0.009). We also analyzed influence of PR status on treatment outcome between patients who received adjuvant trastuzumab and those who did not. In patients who received adjuvant trastuzumab, there was no difference of DFS or OS according to PR status. However, in patients who did not receive adjuvant trastuzumab, ER+/HER2+/PR- patients showed worse DFS than ER+/HER2+/PR+ patients (p=0.006). Conclusions: In patients with ER+/HER2+ breast cancer, we found that a prognostic value of PR only retained in those who did not receive adjuvant trastuzumab. Our findings suggest that the use of adjuvant trastuzumab may offer less clinical benefit for the patients with ER+/HER2+/PR+ breast cancer. Citation Format: Lee HW, Ahn SG, Park JT, Yang BS, Park S, Jeong J, Kim SI. The association between the expression of progesterone receptor and clinical benefit of adjuvant trastuzumab in estrogen receptor-positive and HER2-positive breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-10.

BackgroundThe rate of sudden cardiac death (SCD) for hemodialysis (HD) patients is significantly higher than that observed in the general population and have the highest risk for arrhythmogenic death. In this study, we examined serial electrocardiography (ECG) data in patients undergoing HD and determined their associations with the occurrence of SCD.Method In the retrospective review of three tertiary referral hospitals from November 1986 to November 2016, Patients starting HD in each hospital were enrolled; they underwent regular check-ups at least twice a Measurements and Main Results Of 678 enrolled subjects who underwent serial ECG before and after HD, 291 died and 39 developed SCD. In the pre-HD ECG, SCD patients had significantly longer QT peak-to-end (QTpe) intervals in all leads (II, III, aVF, and V1-6, P<0.001) and a longer QRS duration (92.6±14.0 vs. 100.6±14.9 ms, P=0.015) than survivors. However, in the post-HD ECG, there were no significant differences in any of the variables (QTpe interval at all leads, QRS duration, and proportion of patients with atrial fibrillation) that showed differences in the pre-HD ECG analysis. Moreover, the SCD group showed a significant change in the QTpe interval of the inferior, anterior, and lateral leads before and after HD compared with the survivor group (all leads, P<0.001). A cut-off value of 148.1 ms for the QTpe interval at the V2 lead in pre-HD was determined using receiver operating characteristic curve analysis, and QTpe intervals >148.1 ms were significantly associated with SCD after adjusting for age and sex in multivariable analysis (hazard ratio: 5.675, confidence interval: 2.373–13.575).Conclusions In end-stage kidney disease patients, the QTpe interval at all leads and QRS duration were shortened after HD. Patients with a longer QTpe interval before HD and large changes in ECG parameters after HD might be at a higher risk of SCD. Therefore, changes in the ECG before and after HD could help to predict SCD.

Objective: To evaluate the feasibility of shear-wave elastography using breast ultrasonography in identifying metastasis of removed sentinel lymph nodes during the operation for treatment of breast cancer. Background: Conventional method for identification of sentinel nodal metastasis is time and cost consuming. The optimal method for identification of nodal status is important. Methods: Excised sentinel lymph nodes during the operation were prospectively examined with the elastography. Metastatic status of lymph nodes was confirmed with permanent histology. Only macrometastasis was regarded as positive. Elastic values measured by the ex vivo elastography and nodal characteristics were analyzed to correlate with nodal metastasis. Results: A total of 274 lymph nodes harvested from 68 breast cancer patients at Gangnam Severance Hospital from May 2014 to April 2015 were included this study. There was the difference of elastic values between nodes with and without metastasis (mean stiffness, 41.6 kPa and 17.4 kPa, P &lt; 0.001). Mean sizes of metastatic nodes (range 0.36-2.59 cm) were significantly larger than that of non-metastatic nodes (1.0 cm versus 0.75 cm, P &lt; 0.001). Moreover, there was a correlation between the size of metastatic nodes which ranged from 0.7 to 21.5 mm with a median of 7 mm and nodal stiffness (correlation coefficient of mean stiffness, r = 0.431). The area under the receiver operating characteristic curve (AUC) by the mean stiffness was 0.794. The combination of size of nodes, mean stiffness and ratio made AUC of 0.856. Conclusions: In our study, ex vivo shear-wave elastography of sentinel lymph nodes was a feasible method to predict metastasis. Through the validation study, ex vivo elastography could be helpful to determine metastasis of sentinel lymph nodes during the operation. Keywords Breast cancer; Elastography; Lymph node metastasis. Citation Format: Lim JW, Lee HW, Park JT, Ahn SG, Jung J. Ex vivo shear-wave elastography of axillary lymph nodes predicting nodal metastasis in patients with primary breast cancer: A pilot study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-36.