$20 Poster Session L Predictive and Prognostic Factors

Method: From 01/01 to 12/03 a number of 509 BC patients were examined by mammography as initial diagnostics. All these patients were consecutively and prospectively documented concerning mammography, ultrasound and clinical examination. Diagnostic methods were compared to postoperative histopathological and staging parameters. Pearson's correlation was tested for the complete spot check. The deviation of MG, BU and CE to pT was analyzed in subgroups defined by pathological tumor size (pT), grading (G), estrogen receptor (ER), progesteron receptor (PR), proliferation defined by MIB-1 and HER2/neu. Correlation of AU and pN was examined by x2-test. To test the prediction of a pT>2cm Receiver operating characteristics (ROC) were used.

Results: Comparing the imaging modalities with pT mammography cor- related best with a coefficient r=0,774. Ultrasound revealed a r=0,645 and clinical examination a r=0,698. All correlations were highly significant (p<0,001). Mammography (mean(MG)=2,196cm) overestimated tumors in size (mean(pT)=2,045cm) rather than ultrasound (mean(BU)=1,896cm) and clinical examination (mean(cT)=1,733cm). The size of invasive ductal carci- nomas could be estimated significantly better than invasive Iobular tumors as well as smaller tumors and tumors with a Grading GI. None of the other parameters showed significance. Best predictor of a pT>2cm was the mam- mography with an area under the ROC (AUC) of 0,873. The combination of all three modalities by linear regression performed even better with an AUC of 0,883.

Conclusions: All three methods showed accurate means values for the assessment of the tumor size. The dimension of invasive ductal carcinomas, small and low grading tumors is significant better to estimate. Concerning treatment decisions we propose a combination of all three modalities as we could show the best predictive value for the complementary use of mam- mography, ultrasound and clinical examination.

[ - ~ Semiquantitative analysis of diffuse pattern of 99m Tc-V-DMSA scintimammography in the evaluation of in situ breast carcinomas: A feasible prognostic marker?

V. Papantoniou 1 , J. Koutsikos 1 , M. Bembi 2, S. Tsiouris 1 , M. Sotiropoulou 3, K. Mainta 1, D. Lazaris 4, C. Zerva 1. i Alexandra University Hospital, Nuclear Medicine Department, Athens, Greece; 2 laso Hospital, Department Of Obstetrics & Gynaecology, Athens, Greece; 3 Alexandra University Hospital, Department of Pathology, Athens, Greece; 4 Alexandra University Hospital, Department of Obstetrics & Gynaecology, Athens, Greece

Aim: To assess the ability of diffuse accumulation of 99m Tc-V-DMSA to image in situ breast carcinoma visually and semi-quantitatively.

Materials and methods: A total of 71 women (mean age 62.5 years) that referred with suspicious breast lesions on physical examination and/or an ab- normal mammogram, underwent 99m Tc-V-DMSA scintimammography prior to any surgical intervention. Lateral prone and anterior supine images were acquired at approximately 10 and 60 min after administration of 925-1110 MBq of the radiotracer. Increased focal radiotracer accumulation, as com- pared to surrounding tissue, was assessed as suggestive of invasive cancer. Diffuse increased accumulation was considered as suggesting in-situ carci- noma and further analyzed semi-quantitatively with Tumor/Background (T/B) ratio and compared (t-test) between 10 and 60 min. Scintigraphic results and T/B ratio were compared(t-test) with the presence or absence of microcalci- fications in mammograms.

Results: Breast cancer was histologicaly confirmed in 43/71 patients (in- vasive cancer in 24 and in situ cancer (with or without invasive component) in 19 patients). Diffuse V-DMSA pattern was presented in 30 patients: 18/19 pts with in situ carcinomas (16 DCIS, 2 LCIS), 2/24 pts with invasive cancer (microcentric ductal carcinoma) and 10/28 pts with benign lesions associ- ated with epithelial hyperplasia. The sensitivity, specificity, accuracy, positive and negative predictive value for in situ carcinoma were 95%, 77%, 82%, 60% and 98% respectively. The diffuse pattern of in-situ demonstrated a ten- dency to increase over time (T/B10 min 1.274-0.22 vs. T/BC0 min 1.764-0.25; P<0.01 ). On the contrary, the focal uptake in invasive cancer did not increase significantly (T/B10 min 1.764-0.28 vs. T/BC0 min 1.94-0.28; P>0.05). Mam- mography depicted suspicious microcalcifications in only half of in-situ cases (10/19; 53%). The diffuse uptake was significantly higher in in-situ patients with microcalcifications, as compared to those without (T/BC0 min 1.814-0.05 vs. 1.44-0.07; P=0.003).

Conclusion: The findings of this study indicate the potential value of 99m Tc-V-DMSA scintimammography in imaging in situ breast carcinomas. The semiquantitative analysis of diffuse pattern of 99mTc-V-DMSA scintimam- mography in combination with mammographic findings could provide useful preoperative information.

Thursday, 27 January 2005

Breast cancer screening of Korean women M. Hur 1 , H. Song 1 , S. Ko 1 , H. Lee 1 , S. Kang 1 , B. Cho 2, K. Lee 2, J. Lee 1 . i Sungkyungkwan University, School of Medicine, Samsung Cheil Hospital, General Surgery, Seoul, South Korea; 2 Sungkyunkwan University, School of Medicine, Samsung Cheil Hospital, Radiology, Seoul, South Korea

Background: The screening campaigns of breast cancer have been con- stantly increasing since the benefit of screening in breast cancers had been established. The purpose of this study was to evaluate the efficacy of annual breast screening, which included a mammography and a clinical physical examination.

Methods: From March 1995 to July 2004, we performed 110,588 annual clinical examinations and mammographies on 58,024 women, who wanted to undergo breast cancer screening at this breast center. Two hundred fourteen breast cancers were detected during screening, and of these, 161 patients were operated. The results were compared with the ideal rates for medical audits.

Results: Of the 110,588 cases screened, the recall rate for further ex- amination was 12.1%(n=13,423). And the biopsy rate was 1.01%(n=1,116). 214 breast cancers were detected; a detection rate of 0.19%. One hundred thirty four patients were the 1 st visitors at this center. The pathologic results of benign disease after biopsies were ordered fibrocystic change, fibroade- noma, adenosis, etc. Invasive ductal cancer is the most common among cancers. Stage 0 among cancers was 23.6%, Stage I was 40.4%, stage II a was 19.9, stage lib and Ilia was 6.2%. Stage IIIc was 3.1%. Also, Stage IV is 0.6%. Positive predictive value(PPV) based on abnormal findings at screening examination was 1.6%(PPV1). PPV when a biopsy or surgical consultation were recommended, was 19.1%(PPV2). Tumor found as stage 0 or I was 64%(103/161). Tumor found as minimal cancer(stage 0 or tumor lesser than lcm) was 38.5%(62/161). There were 38 cases of axillary lymph node metastasis(23.6%). Cancers found per 1,000 cases was 1.7. Preva- lence cancer found per 1,000 first examinations was 2.3. Incidental cancer found per 1,000 follow-up examinations was 1.2. These results were compat- ible with the ideal rates for medical audits, except for PPV1, PPV2, cancers found per 1,000 cases.

Conclusion: This breast cancer screening was properly performed. These findings indicate that breast cancer screening using a clinical exami- nation and a mammography is very effective in the early detection of breast cancer.

THURSDAY, 27 JANUARY 2005

Predictive and Prognostic Factors

IP231 Hypermethylation of E-cadherin, GSTP1, 14-3-3~ and TIMP-3 genes as prognostic markers in invasive ductal breast carcinoma

Louis w.C. Chow, Eric L.H. Lui, Wings T.Y. Loo, Mary N.B. Cheung. Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong

DNA hypermethylation of TSGs is an important cause of cancer formation. Different types of cancers have different sets of regional-hypermethylated TSGs (hypermethylation patterns), resulting in each tumor type having dis- tinctive characteristics. The hypermethylation status of many TSGs, which is potentially responsible in causing IDC, were investigated in this study and they were correlated with the clinical pathological records of the corre- sponding cancer patients. 155 samples of IDC were collected, each of which had DNA extraction and MSP performed preceded by pathological examina- tion. The percentage of hypermethylated TSGs were: Ecad 18.42%, GSTP1 31.71 %, 14-3-3s 94.97% and TIMP3 20.81%. Within the above groups, Ecad had a strong positive correlation with lymph node metastasis. Hypermethy- lation of GSTP1 and TIMP3 and 14-3-3s was associated with HER2 overex- pression and high tumor grade. The four TSGs tested may serve as potential markers for the corresponding characteristics of IDC since they were related to some of the histopathological status. Our observations also suggested that HER2 might potentially induce hypermethylation of Ecad gene.