BACKGROUND & AIMS: BACKGROUND:Neoadjuvant chemotherapy (NAC) is increasingly used in the framework of breast-conserving therapy (BCT). Localization of the initial tumor is essential to guide surgical resection after NAC. This study describes the results obtained with I-125 seed localization in BCT including NAC. PATIENTS AND METHODS:Between January 2009 and December 2010, 85 patients treated with NAC and BCT after I-125 seed localization were included. Radiological and pathological response and resection margins were retrospectively evaluated. RESULTS:BCT was carried out in 85 patients without secondary local excisions. Nineteen patients with unifocal tumors and seven patients with multifocal tumors showed a complete pathological response (P = 0.18). Tumor-free resection margins were obtained in 78 patients (50 patients with unifocal and 28 patients with multifocal tumors, P = 0.27). Focally involved margins were found in four patients (two patients with a unifocal and two patients with a multifocal tumor, P = 0.27). A subsequent mastectomy was carried out in three patients (two patients with multifocal tumors, P = 0.29). CONCLUSIONS:BCT after NAC can be carried out successfully after initial localization with I-125 seeds in both unifocal and multifocal breast tumors with complete resection rates of >90%.

背景与目标： 背景：新辅助化疗（NAC）越来越多地用于保乳治疗（BCT）的框架中。初始肿瘤的定位对于NAC术后的手术切除至关重要。这项研究描述了I-125种子在包括NAC的BCT中的定位所获得的结果。
患者和方法：2009年1月至2010年12月，纳入I-125种子定位后接受NAC和BCT治疗的85例患者。回顾性评估放射学和病理学反应以及切除范围。
结果：85例患者均进行了BCT检查，未进行次要局部切除。 19例单灶性肿瘤患者和7例多灶性肿瘤患者表现出完全的病理反应（P = 0.18）。 78例患者获得了无肿瘤切除切缘（50例单灶患者和28例多灶肿瘤患者，P = 0.27）。在四名患者中发现了局部受累的切缘（两名单灶患者和两名多灶性肿瘤患者，P = 0.27）。随后在三名患者中进行了乳房切除术（两名患有多灶性肿瘤的患者，P = 0.29）。
结论：NAC后的BCT可以在单灶和多灶乳腺肿瘤中首次定位I-125种子后成功进行，完全切除率> 90％。

BACKGROUND & AIMS: PURPOSE:To evaluate outcomes among early-stage breast cancer patients after conservative surgery and full-dose intraoperative radiotherapy electrons (ELIOT) by applying the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) recommendations for partial breast irradiation (APBI). MATERIALS AND METHODS:One-thousand eight-hundred and twenty-two patients were stratified into the three GEC-ESTRO categories of "good candidates", "possible candidates" and "contraindication" in order to assess outcomes. RESULTS:All the 1822 cases except 7 could be classified according to GEC-ESTRO groups: 573 patients met the criteria to be included in the "good candidates" group, 468 patients in the "possible candidates" group and 767 patients in the "contraindication" group. Median and mean follow-up length was 3.5 years (range 0-10.5 years) and 3.8 years (SD 2.2), respectively. The 5-year rate of in-breast tumor reappearances for "good candidates", "possible candidates" and "contraindication" groups were 1.9%, 7.4% and 7.7%, respectively (p 0.001). While the regional node relapse showed no difference, the rate of distant metastases was significantly different in the "contraindication" group compared to the other two categories, having a significant impact on survival. CONCLUSIONS:Among the ELIOT population, the GEC-ESTRO recommendations enabled the selection of the good candidates with a low rate of local recurrence, but failed to differentiate the "possible candidates" and the "contraindication" groups.

背景与目标： 目的：通过应用欧洲放射治疗和肿瘤学学会（GEC-ESTRO）对部分乳房照射的建议，评估保守手术和全剂量术中放疗电子（ELIOT）后早期乳腺癌患者的结局（APBI）。
材料与方法：将128例患者分为GEC-ESTRO的“好候选人”，“可能候选人”和“禁忌症”三个类别，以评估结果。
结果：除7例外，其余1822例均可以根据GEC-ESTRO组进行分类：573例符合“好候选者”组的标准，468例“可能候选”组的患者，767例“禁忌症”的患者“ 团体。中位和平均随访时间分别为3。5年（0-10。5年）和3。8年（SD 2.2）。 “好候选者”，“可能候选者”和“禁忌症”组的5年乳腺肿瘤复发率分别为1.9％，7.4％和7.7％（p 0.001）。尽管区域淋巴结复发无差异，但“禁忌”组中远处转移的发生率与其他两类相比有显着差异，对生存率有显着影响。
结论：在ELIOT人群中，GEC-ESTRO的建议使得能够选择局部复发率低的良好候选者，但未能区分“可能候选者”和“禁忌症”人群。

BACKGROUND & AIMS: BACKGROUND:Evidence-based guidelines recommend limited perioperative diagnostic imaging for new breast cancer diagnoses. For patients aged >65 years, conventional imaging use (mammography, plain radiographs, and ultrasound) has remained stable, whereas advanced imaging (computed tomography [CT], nuclear medicine scans [positron emission tomography/bone scans], and magnetic resonance imaging [MRI]) use has increased. In this study, the authors evaluated traditional and advanced imaging use among younger patients (aged ≤ 65 years) undergoing breast cancer surgery. METHODS:The MarketScan Commercial Claims and Encounters Research Database from 2005 through 2008 was analyzed to evaluate the use of conventional and advanced diagnostic imaging associated with surgery for ductal carcinoma in situ (DCIS) or stage I through III invasive breast cancer. RESULTS:The study cohort included 52,202 women (13% with DCIS and 87% with stage I-III breast cancer). The proportion of patients undergoing conventional imaging remained stable, whereas the average number of conventional imaging tests per patient increased from 4.21 tests in 2005 to 4.79 tests per patient in 2008 (P < .0001). For advanced imaging, the proportion of women who underwent imaging increased from 48.8% in 2005 to 68.8% in 2008 (P < .0001), as did the number of tests per patient (from 1.53 tests in 2005 to 1.98 tests in 2008; P < .0001). MRI examinations accounted for nearly all of the increase in advanced imaging. Patients who underwent MRI examinations received significantly more traditional imaging tests compared with to those who did not, indicating that these tests are additive and are not replacing traditional imaging. CONCLUSIONS:The current results demonstrate that the use of perioperative breast MRI has increased among women aged <65 years. Further study is indicated to determine whether the benefits of this procedure justify increased use.

背景与目标： 背景：基于证据的指南建议对新的乳腺癌进行有限的围手术期诊断成像。对于65岁以上的患者，传统的影像学检查（乳房X线照片，X线平片和超声检查）保持稳定，而高级影像学（计算机断层扫描[CT]，核医学扫描[正电子发射断层扫描/骨扫描]和磁共振成像[ MRI]）的使用有所增加。在这项研究中，作者评估了接受乳腺癌手术的年轻患者（≤65岁）的传统和高级成像使用情况。
方法：对2005年至2008年的MarketScan商业索赔和遭遇研究数据库进行了分析，以评估与导管原位癌（DCIS）或I至III期浸润性乳腺癌手术相关的常规和高级诊断成像的使用。
结果：该研究队列包括52,202名妇女（13％的DCIS患者和87％的I-III期乳腺癌患者）。接受常规影像学检查的患者比例保持稳定，而每名患者的常规影像学检查的平均次数从2005年的4.21次检查增加到2008年的4.79次检查（P <.0001）。对于高级影像学，接受影像学检查的女性比例从2005年的48.8％增加到2008年的68.8％（P <.0001），每位患者的检查次数也从2005年的1.53次增加到2008年的1.98次； P <.0001）。 MRI检查几乎占了高级影像学增长的全部。与未接受MRI检查的患者相比，接受过MRI检查的患者接受的传统成像检查要多得多，这表明这些检查是相加的，不能替代传统成像。
结论：目前的结果表明，<65岁的女性围手术期乳房MRI的使用有所增加。指示需要进一步研究以确定该程序的益处是否可以证明增加使用的合理性。

BACKGROUND & AIMS: INTRODUCTION:Fatigue after treatment for breast cancer (BC) is common, but poorly understood. We examined the fatigue levels during first year after radiotherapy (RT) according to the extent of RT (local or locoregional), hormonal therapy (HT) and chemotherapy (CT). The impact of comorbidity was also explored. Moreover, we compared fatigue levels in patients with the general population (GenPop) data. MATERIAL AND METHODS:BC patients (n = 250) referred for post-operative RT at St. Olavs Hospital, Trondheim, Norway, were enrolled. Fatigue was measured by the EORTC QLQ-C30-fatigue subscale, ranging from 0 to 100, before RT (baseline), after RT, and at three, six, and 12 months. Clinical and treatment-related factors were recorded at baseline. GenPop data was available from a previous survey (n = 652). Linear mixed models and analysis of covariance were applied. RESULTS:Compliance ranged from 87% to 98%. At baseline, mean value (SD) of fatigue in BC patients was 26.8 (23.4). The level increased during RT (mean change 8.3, 95% CI 5.5-11.1), but declined thereafter and did not differ significantly from pre-treatment levels at subsequent time points. In age-adjusted analyses, locoregional RT accounted for more overall fatigue than local RT (mean difference 6.6, 95% CI 1.2-12.0), but the association was weakened and not statistical significant when adjusting for CT and HT. Similar pattern was seen for CT and HT. The course of fatigue differed significantly by CT (p < 0.001, interaction test). At baseline, fatigue levels were higher in patients with than without CT, but at subsequent time points similar levels were evident, indicating a temporary adverse effect of CT. Comorbidity was significantly associated with increased level of fatigue, independent of other factors (mean difference 8.1, 95% CI 2.2-14.1). BC-patients were not significantly more fatigued than GenPop, except for immediately after ending RT, and then only among those without comorbidity (mean 35.9 vs. 25.8, p < 0.001). CONCLUSION:Comorbidity seems to be a more important determinant for fatigue levels than the cancer treatment.

背景与目标： 简介：乳腺癌（BC）治疗后的疲劳很普遍，但了解甚少。我们根据放疗（局部或局部），激素治疗（HT）和化学疗法（CT）的程度，检查了放疗（RT）后第一年的疲劳水平。还探讨了合并症的影响。此外，我们将一般人群（GenPop）数据的患者的疲劳水平进行了比较。
材料与方法：招募了在挪威特隆赫姆的圣奥拉夫斯医院接受手术后放疗的BC患者（n = 250）。疲劳通过EORTC QLQ-C30疲劳分量表进行测量，范围为0至100，RT前（基线），RT后以及3、6和12个月。在基线记录临床和治疗相关因素。 GenPop数据可从以前的调查中获得（n = 652）。应用线性混合模型和协方差分析。
结果：依从性从87％到98％不等。基线时，BC患者的疲劳平均值（SD）为26.8（23.4）。在放疗期间该水平升高（平均变化8.3，95％CI 5.5-11.1），但此后下降，并且在随后的时间点与治疗前水平无显着差异。在年龄校正的分析中，局部RT比局部RT引起的总体疲劳要多（平均差异6.6，95％CI 1.2-12.0），但是当校正CT和HT时，关联性减弱并且没有统计学意义。 CT和HT观察到相似的模式。 CT的疲劳过程明显不同（p <0.001，相互作用测试）。在基线时，有CT的患者的疲劳水平高于没有CT的患者，但是在随后的时间点，相似的水平也很明显，表明CT的暂时不良反应。与其他因素无关，合并症与疲劳程度增加显着相关（平均差异8.1，95％CI 2.2-14.1）。 BC患者没有比GenPop明显疲劳，除了RT结束后立即缓解，然后才出现在没有合并症的患者中（平均35.9 vs. 25.8，p <0.001）。
结论：合并症似乎是比癌症治疗更为重要的疲劳程度决定因素。

BACKGROUND & AIMS: :Upregulation of lipogenesis is a hallmark of cancer and blocking the lipogenic pathway is known to cause tumor cell death by apoptosis. However, the exact role of lipogenesis in tumor initiation is as yet poorly understood. We examined the expression profile of key lipogenic genes in clinical samples of ductal carcinoma in situ (DCIS) of breast cancer and found that these genes were significantly upregulated in DCIS. We also isolated cancer stem-like cells (CSCs) from DCIS.com cell line using cell surface markers (CS24(-)CD44(+)ESA(+)) and found that this cell population has significantly higher tumor-initiating ability to generate DCIS compared with the non-stem-like population. Furthermore, the CSCs showed significantly higher level of expression of all lipogenic genes than the counterpart population from non-tumorigenic breast cancer cell line, MCF10A. Importantly, ectopic expression of SREBP1, the master regulator of lipogenic genes, in MCF10A significantly enhanced lipogenesis in stem-like cells and promoted cell growth as well as mammosphere formation. Moreover, SREBP1 expression significantly increased the ability of cell survival of CSCs from MCF10AT, another cell line that is capable of generating DCIS, in mouse and in cell culture. These results indicate that upregulation of lipogenesis is a pre-requisite for DCIS formation by endowing the ability of cell survival. We have also shown that resveratrol was capable of blocking the lipogenic gene expression in CSCs and significantly suppressed their ability to generate DCIS in animals, which provides us with a strong rationale to use this agent for chemoprevention against DCIS.

背景与目标： ：脂肪生成的上调是癌症的标志，已知阻断脂肪生成途径会通过凋亡导致肿瘤细胞死亡。然而，尚不清楚脂肪生成在肿瘤起始中的确切作用。我们检查了乳腺导管原位癌（DCIS）临床样品中关键脂肪形成基因的表达谱，发现这些基因在DCIS中显着上调。我们还使用细胞表面标记（CS24（-）CD44（）ESA（））从DCIS.com细胞系中分离了癌干样细胞（CSCs），发现与该细胞相比，该细胞群具有更高的产生DCIS的肿瘤启动能力与非茎状种群。此外，CSCs显示所有脂肪形成基因的表达水平均高于非致瘤性乳腺癌细胞系MCF10A的对应群体。重要的是，MCF10A中脂生成基因的主要调控因子SREBP1的异位表达显着增强了干细胞样脂质的生成，并促进了细胞的生长以及乳球的形成。此外，SREBP1表达显着提高了来自MCF10AT的CSC细胞的存活能力，MCF10AT是另一种能够在小鼠和细胞培养物中产生DCIS的细胞系。这些结果表明，通过赋予细胞存活能力，脂肪生成的上调是DCIS形成的先决条件。我们还表明，白藜芦醇能够阻断CSC中脂肪基因的表达，并显着抑制其在动物体内生成DCIS的能力，这为我们提供了使用该药物化学预防DCIS的强大理由。

BACKGROUND & AIMS: :The imaging of breast cancer has undergone significant progression in recent years. A multimodality approach is often required, with ongoing developments in mammography, ultrasound, magnetic resonance and nuclear medicine all contributing to breast cancer imaging. Here we review the literature to assess how advances in well-established technologies, such as mammography, have brought added benefits both in terms of diagnostic and practical benefits, as well as allowing the application of derived technologies, such as tomosynthesis and contrast-enhanced mammography. We consider how these newer technologies may fit into clinical practice, both in terms of general population screening as well as use as problem solving tools in specific patient groups, and where the limitations for these may lie. We aim to highlight some of the promising advances in imaging that are still in earlier stages, such as magnetic resonance elastography, as well as reviewing techniques that are already becoming incorporated into clinical practice.

背景与目标： ：近年来，乳腺癌的影像学经历了重大进展。通常需要一种多模态方法，随着乳房X线照片，超声，磁共振和核医学的不断发展，所有这些都有助于乳腺癌的成像。在这里，我们回顾文献以评估诸如乳房X线照相术等成熟技术的进步如何在诊断和实际获益方面带来了额外的好处，以及如何允许诸如断层合成和对比增强的X线照相术等衍生技术的应用。我们从总体人群筛查以及在特定患者群体中用作问题解决工具的角度考虑这些更新技术如何适合临床实践，以及这些方法可能存在的局限性。我们的目标是突出显示仍处于早期阶段的一些有希望的成像进展，例如磁共振弹性成像以及已经纳入临床实践的检查技术。

BACKGROUND & AIMS: :Triple-negative breast cancer is characterized by aggressive tumours whose cells lack oestrogen and progesterone receptors and do not over-express HER2. It accounts for approximately 10-15% of breast cancer cases. We sought to generate a cellular model of chemotherapy drug resistance for this type of disease to provide the tools for the development of new therapies. Doxorubicin is a component of some chemotherapy regimes used to treat this form of cancer but resistance preventing disease eradication frequently occurs, mainly due to over-expression of drug transporters such as P-glycoprotein. CALDOX cells were generated by exposure of CAL51 to doxorubicin. Resistance to doxorubicin did not involve drug transporters, as the both parental and resistant cells accumulated doxorubicin to comparable levels. CALDOX cells had slower proliferation rate and an extended G1 cell cycle stage than the parental line, mainly due to an intrinsic activation of CDNK1 (p21), but this cell cycle block was not involved in the mechanism of resistance. CALDOX cells had reduced levels of TOP2A (topoisomerase IIα) and were cross resistant to the topoisomerase II inhibitors etoposide and mitoxantrone. CALDOX cells showed collateral sensitivity to carmustine due to the lack of O⁶-methylguanine-DNA-methyltransferase (MGMT) expression, related to the hypermethylation of its promoter. The collateral sensitivity of CALDOX cells to carmustine provides the rationale to evaluate MGMT promoter methylation status to design better therapeutic strategies for triple negative breast cancer.

背景与目标： 三阴性乳腺癌的特征是侵袭性肿瘤，其细胞缺乏雌激素和孕激素受体，并且不会过度表达HER2。它约占乳腺癌病例的10-15％。我们试图为这种类型的疾病生成化学疗法抗药性的细胞模型，以提供开发新疗法的工具。阿霉素是一些用于治疗这种形式癌症的化学疗法的组成部分，但经常会出现防止根除疾病的抗药性，这主要是由于药物转运蛋白（例如P-糖蛋白）的过度表达所致。通过将CAL51暴露于阿霉素可产生CALDOX细胞。对阿霉素的耐药性不涉及药物转运蛋白，因为亲代细胞和耐药细胞都将阿霉素蓄积到可比较的水平。 CALDOX细胞的增殖速率较亲本系慢，且G1细胞周期延长，这主要归因于CDNK1（p21）的内在激活，但该细胞周期阻滞并不参与耐药机制。 CALDOX细胞的TOP2A（拓扑异构酶IIα）水平降低，并且对拓扑异构酶II抑制剂依托泊苷和米托蒽醌具有交叉耐药性。由于缺乏与启动子的高甲基化有关的O⁶-甲基鸟嘌呤-DNA-甲基转移酶（MGMT）表达，CALDOX细胞对卡莫司汀表现出附带敏感性。 CALDOX细胞对卡莫司汀的附带敏感性为评估MGMT启动子甲基化状态提供了理论依据，从而为三阴性乳腺癌设计更好的治疗策略。

BACKGROUND & AIMS: AIM:To ascertain the negative predictive value (NPV) for atypia and malignancy of 14 G core biopsy of papillomas and to determine whether lesion type influences the likelihood of malignancy at lesion excision. MATERIALS AND METHODS:Ninety-six lesions with a 14 G core biopsy diagnosis of benign papilloma without atypia in 95 women were included. The imaging features (mass or microcalcification), biopsy mode, and number of core samples taken were documented. All patients subsequently underwent lesion excision with either extensive vacuum-assisted biopsy (VAB; 72 lesions) or surgery (24 lesions). Mammographic follow-up of at least 2 years was available for 32 lesions that were benign at VAB. RESULTS:Atypia or malignancy was found more commonly in association with microcalcification (six of 29 lesions: 21%; median number of nine 14 G cores) than a mass (five of 67 lesions: 7%; median number of three 14 G cores), although the difference does not reach statistical significance (p = 0.088). The NPV of a 14 G core biopsy diagnosis of papilloma for atypia or malignancy is 89% (85/96). Disease underestimation may be more common in microcalcification lesions despite the greater number of cores obtained. CONCLUSION:Excision (using VAB or surgically) of all papillomas diagnosed as benign on 14 G needle core biopsy is recommended. Surgery may be more appropriate than VAB for some microcalcification lesions unless they are small and can be confidently removed in their entirety using VAB.

背景与目标： 目的：确定乳头状瘤14 G核心活检的非典型性和恶性的阴性预测值（NPV），并确定病变类型是否影响切除病变的恶性可能性。
材料与方法：纳入95例经非常规检查，无异型的良性乳头瘤14G核心活检的96处病变。记录了影像学特征（质量或微钙化），活检模式和采集的核心样本数量。随后，所有患者均接受了广泛的真空辅助活检（VAB； 72个病灶）或手术（24个病灶）的病灶切除。对于VAB良性的32个病灶，可以进行至少2年的乳房X光检查。
结果：发现非典型性或恶性肿瘤与微钙化（29个病变中的六个：21％; 9个14G核的中位数）比肿块（67个病变中的7％：7％;三个14G核的中位数）更为常见，尽管差异未达到统计显着性（p = 0.088）。乳头状瘤非典型性或恶性的14 G核心活检诊断的NPV为89％（85/96）。尽管获得的核心数量较多，但疾病低估可能在微钙化病变中更为普遍。
结论：建议在14 G针芯活检中切除所有被诊断为良性的乳头状瘤（使用VAB或手术）。对于某些微钙化病变，手术可能比VAB更合适，除非它们很小并且可以使用VAB完全切除。

BACKGROUND & AIMS: :The expression of PD-L1 in breast cancer is associated with estrogen receptor negativity, chemoresistance and epithelial-to-mesenchymal transition (EMT), all of which are common features of a highly tumorigenic subpopulation of cancer cells termed cancer stem cells (CSCs). Hitherto, the expression and intrinsic role of PD-L1 in the dynamics of breast CSCs has not been investigated. To address this issue, we used transcriptomic datasets, proteomics and several in vitro and in vivo assays. Expression profiling of a large breast cancer dataset (530 patients) showed statistically significant correlation (p < 0.0001, r = 0.36) between PD-L1 expression and stemness score of breast cancer. Specific knockdown of PD-L1 using ShRNA revealed its critical role in the expression of the embryonic stem cell transcriptional factors: OCT-4A, Nanog and the stemness factor, BMI1. Conversely, these factors could be induced upon PD-L1 ectopic expression in cells that are normally PD-L1 negative. Global proteomic analysis hinted for the central role of AKT in the biology of PD-L1 expressing cells. Indeed, PD-L1 positive effect on OCT-4A and Nanog was dependent on AKT activation. Most importantly, downregulation of PD-L1 compromised the self-renewal capability of breast CSCs in vitro and in vivo as shown by tumorsphere formation assay and extreme limiting dilution assay, respectively. This study demonstrates a novel role for PD-L1 in sustaining stemness of breast cancer cells and identifies the subpopulation and its associated molecular pathways that would be targeted upon anti-PD-L1 therapy.

背景与目标： ：PD-L1在乳腺癌中的表达与雌激素受体阴性，化学抗药性和上皮间质转化（EMT）有关，所有这些都是癌细胞的高度致瘤性亚群（称为癌症干细胞（CSC））的共同特征。迄今为止，尚未研究PD-L1在乳腺CSCs动力学中的表达和内在作用。为了解决这个问题，我们使用了转录组数据集，蛋白质组学以及几种体外和体内测定方法。大型乳腺癌数据集（530例患者）的表达谱显示，PD-L1表达与乳腺癌干性评分之间具有统计学显着相关性（p <0.0001，r = 0.36）。使用ShRNA对PD-L1的特异性敲除显示出它在胚胎干细胞转录因子：OCT-4A，Nanog和干性因子BMI1的表达中的关键作用。相反，这些因素可在正常为PD-L1阴性的细胞中在PD-L1异位表达时被诱导。全球蛋白质组学分析提示AKT在PD-L1表达细胞生物学中的核心作用。实际上，PD-L1对OCT-4A和Nanog的阳性作用取决于AKT激活。最重要的是，PD-L1的下调分别损害了肿瘤球形成试验和极限稀释试验所表明的乳腺CSCs在体外和体内的自我更新能力。这项研究证明了PD-L1在维持乳腺癌细胞干性方面的新作用，并确定了针对抗PD-L1治疗的亚群及其相关的分子途径。

BACKGROUND & AIMS: :Purpose: The immune microenvironment of breast ductal carcinoma in situ (DCIS) has yet to be fully explored, and the relationship of immune cells to genetic features of DCIS is unknown.Experimental Design: We quantified tumor associated lymphocytes (TIL) and evaluated PD-L1 protein levels by immunohistochemistry in a cohort of pure DCIS (138 and 79 cases, respectively), some of which had copy number (n = 55) and mutation data (n = 20).Results: TILs were identified in the stroma surrounding DCIS (119/138, 86%) and present at a median TIL score of 5% (range, 0%-90%). Most DCIS were negative for tumor cell PD-L1 staining (89%), but 25% of cases were positive for immune cell staining. We observed that, as in invasive breast cancer, TILs and PD-L1 positivity were significantly greater in high-grade (P = 0.002/0.035), ER-negative (P = 0.02/0.02), and ERBB2-amplified tumors (P < 0.001/0.048). Comedo necrosis was significantly positively associated with TILs (P < 0.0001) but not with PD-L1. The TILs score was significantly higher in cases with TP53 mutation (P = 0.03) but not with PIK3CA or GATA3 mutation. In the cases with copy number data, both the fraction of the genome altered and the number of telomeric imbalances were significantly positively correlated with TILs (both P < 0.001). This result strongly contrasted with invasive breast cancer data, where aneuploidy was not correlated to TIL levels.Conclusions: Although a small cohort, our data suggest a preliminary model by which the progression of DCIS to invasive carcinoma may involve an altered relationship of tumor copy number with the immune microenvironment, possibly by the immunoediting of the tumor. Clin Cancer Res; 23(17); 5210-7. ©2017 AACR.

背景与目标： 目的：乳腺导管原位癌（DCIS）的免疫微环境尚未得到充分探索，并且免疫细胞与DCIS遗传特征的关系尚不清楚。实验设计：我们量化了肿瘤相关淋巴细胞（TIL）并评估了PD通过免疫组织化学检测一组纯DCIS（分别为138和79例）中的-L1蛋白水平，其中一些具有拷贝数（n = 55）和突变数据（n = 20）。 DCIS（119/138，86％），平均TIL得分为5％（范围：0％-90％）。大多数DCIS对肿瘤细胞PD-L1染色呈阴性（89％），但25％的病例对免疫细胞染色呈阳性。我们观察到，与浸润性乳腺癌一样，高级别（P = 0.002 / 0.035），ER阴性（P = 0.02 / 0.02）和ERBB2扩增的肿瘤中TIL和PD-L1阳性率显着更高（P < 0.001 / 0.048）。痤疮坏死与TILs呈显着正相关（P <0.0001），而与PD-L1无显着正相关。 TP53突变的患者的TILs评分显着更高（P = 0.03），而PIK3CA或GATA3突变的患者则没有。在具有拷贝数数据的情况下，基因组的比例改变和端粒失衡的数目均与TILs显着正相关（均P <0.001）。该结果与浸润性乳腺癌数据形成鲜明对比，后者的非整倍性与TIL水平无关。结论：尽管队列比较小，但我们的数据提示了初步模型，通过该模型DCIS向浸润性癌进展可能涉及肿瘤拷贝数关系的改变免疫微环境，可能是通过肿瘤的免疫编辑。临床癌症研究； 23（17）; 5210-7。 ©2017 AACR。

BACKGROUND & AIMS: OBJECTIVE:Breast-feeding is associated with maternal health, such as electrolyte metabolism, lipid profile and body component change. The aim of this study was to evaluate the relationship between duration of breast-feeding and obesity in postmenopausal women. METHODS:We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012, a cross-sectional study in a Korean population. A total of 6621 postmenopausal women were analyzed. RESULTS:Body mass index and waist circumference were greater in women who had breast-fed for 6 months or more than in those who had not (BMI: 23.7±0.1 vs 24.5±0.1, P<0.0001; WC: 80.6±0.4 vs 82.8±0.3, P<0.001). This association persisted after adjustment for confounding factors (BMI: odds ratio[OR]1.54, 95% confidence interval[CI] 1.19-2.0; WC: OR1.67, 95% CI 1.29-2.17). The duration of breast-feeding tended to increase with increasing BMI and WC (P for trend, 0.001 for each). The proportions of women with greater BMI and WC increased with increasing duration of breast-feeding (27.3% in ≤6 months vs 41.2% in >18months, P<0.0001). CONCLUSION:The results of this study suggest that prolonged breast-feeding may be associated with greater BMI and WC among postmenopausal women.

背景与目标： 目的：母乳喂养与孕妇健康有关，例如电解质代谢，脂质分布和身体成分变化。这项研究的目的是评估绝经后妇女的母乳喂养时间与肥胖之间的关系。
方法：我们分析了2010-2012年韩国国民健康与营养检查调查（KNHANES）的数据，这是一项针对韩国人群的横断面研究。总共对6621名绝经后妇女进行了分析。
结果：母乳喂养6个月或更长时间的妇女的身体质量指数和腰围比没有母乳的妇女更大（BMI：23.7±0.1 vs 24.5±0.1，P <0.0001; WC：80.6±0.4 vs 82.8 ±0.3，P <0.001）。调整混杂因素（BMI：比值比[OR] 1.54，95％置信区间[CI] 1.19-2.0； WC：OR1.67，95％CI 1.29-2.17）后，这种关联仍然存在。母乳喂养的时间倾向于随着BMI和WC的增加而增加（趋势P，每种0.001）。 BMI和WC较高的女性比例随着母乳喂养时间的增加而增加（≤6个月为27.3％，而> 18个月为41.2％，P <0.0001）。
结论：这项研究的结果表明，延长母乳喂养可能与绝经后妇女的BMI和WC升高有关。

BACKGROUND & AIMS: :Objective: To determine the effect of electro-acupuncture (EA) treatment on serum levels of interferon-γ (IFN-γ) in rats with 7,12-dimethylbenz(α)anthracene (DMBA)-induced breast tumors. Methods: Twenty five female Wistar rats were divided randomly into 5 groups: normal group (N; neither DMBA-induced nor treated with EA); control group (C; DMBA-induced only); EA 3 days : (DMBA-induced + EA for 3 days); EA 5 days: (DMBA-induced + EA for 5 days); EA 10 days: (DMBA-induced + EA for 10 days) group. Animals were acclimatized from day 1 to day 7. Subcutaneus injections of DMBA 10mg/kg BW was administered every second day, from days 7 to 35. Acupuncture was performed every second day from day 42. Rats were sacrificed on the second day after the last acupuncture, breast tumors excised and stained histological sections were analysed by light microscopy. At sacrifice, blood was extracted from the heart for measurement of serum IFN-γ by ELISA. Results: All of the DMBA-induced rats developed tumors. Electro-acupuncture significantly increased IFN-γ levels in DMBA induced rats, when compared to control group. Conclusions: Our findings suggest that EA significantly increases IFN-γ levels in DMBA-induced breast tumors.

背景与目标： ：目的：确定电针治疗对血清中干扰素-γ（IFN-γ）水平的影响
在患有7,12-二甲基苯并（α）蒽（DMBA）诱导的乳腺肿瘤的大鼠中。方法：25名女性Wistar
将大鼠随机分为5组：正常组（N；既不是DMBA诱导的，也不是用EA治疗的）。控制
组（C；仅DMBA诱导）； EA 3天：（DMBA诱导的EA 3天）； EA 5天：（DMBA诱导的EA
5天）; EA 10天：（DMBA诱导的EA 10天）组。从第1天到第7天使动物适应环境。
从第二天到第7天至第35天，皮下注射DMBA 10mg / kg体重。
从第42天起每隔第二天进行一次。最后一次针刺后第二天将大鼠处死，
通过光学显微镜分析切除的肿瘤和染色的组织学切片。牺牲时，血液被抽出
从心脏通过ELISA测定血清IFN-γ。结果：所有DMBA诱导的大鼠均出现肿瘤。
与对照组相比，电针显着增加了DMBA诱导的大鼠的IFN-γ水平。
结论：我们的发现表明，EA可以显着增加DMBA诱导的乳腺肿瘤中的IFN-γ水平。

BACKGROUND & AIMS: :Early diagnosis of breast cancer is essential to save lives of patients. Usually, medical datasets include a large variety of data that can lead to confusion during diagnosis. The Knowledge Discovery on Database (KDD) process helps to improve efficiency. It requires elimination of inappropriate and repeated data from the dataset before final diagnosis. This can be done using any of the feature selection algorithms available in data mining. Feature selection is considered as a vital step to increase the classification accuracy. This paper proposes a Modified Bat Algorithm (MBA) for feature selection to eliminate irrelevant features from an original dataset. The Bat algorithm was modified using simple random sampling to select the random instances from the dataset. Ranking was with the global best features to recognize the predominant features available in the dataset. The selected features are used to train a Random Forest (RF) classification algorithm. The MBA feature selection algorithm enhanced the classification accuracy of RF in identifying the occurrence of breast cancer. The Wisconsin Diagnosis Breast Cancer Dataset (WDBC) was used for estimating the performance analysis of the proposed MBA feature selection algorithm. The proposed algorithm achieved better performance in terms of Kappa statistic, Mathew’s Correlation Coefficient, Precision, F-measure, Recall, Mean Absolute Error (MAE), Root Mean Square Error (RMSE), Relative Absolute Error (RAE) and Root Relative Squared Error (RRSE).

背景与目标： ：早期诊断乳腺癌对于挽救患者生命至关重要。通常，医学数据集包括各种各样
可能导致诊断过程中混乱的数据。数据库知识发现（KDD）流程有助于
提高效率。在最终诊断之前，需要从数据集中消除不适当和重复的数据。
这可以使用数据挖掘中可用的任何特征选择算法来完成。考虑功能选择
作为提高分类准确性的重要步骤。本文针对特征提出了一种改进的Bat算法（MBA）
选择以从原始数据集中消除不相关的特征。使用简单随机算法修改了Bat算法
采样以从数据集中选择随机实例。排名具有全球最佳功能，可识别
数据集中可用的主要特征。所选要素用于训练随机森林（RF）分类
算法。 MBA特征选择算法提高了RF在识别事件中的分类精度
乳腺癌。威斯康星州诊断乳腺癌数据集（WDBC）用于评估性能
提出的MBA特征选择算法的分析。提出的算法取得了较好的性能。
Kappa统计数据，Mathew的相关系数，精度，F度量，召回率，平均绝对误差（MAE），
均方根误差（RMSE），相对绝对误差（RAE）和均方根误差（RRSE）。

BACKGROUND & AIMS: PURPOSE:Many women with hormone receptor-positive breast cancer discontinue effective aromatase inhibitor (AI) treatment due to joint symptoms. METHODS:We conducted a single-arm, open-label, phase II study evaluating glucosamine-sulfate (1,500 mg/day) + chondroitin-sulfate (1,200 mg/day) for 24 weeks to treat joint pain/stiffness in postmenopausal women with early stage breast cancer who developed moderate-to-severe joint pain after initiating AIs. The primary endpoint was improvement in pain/stiffness at week 24 assessed by the Outcome Measure in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria. Secondary endpoints assessed changes in pain, stiffness, and function using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index for hips/knees and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH) for hands/wrists. The Brief Pain Inventory (BPI) assessed pain interference, severity, and worst pain. RESULTS:Of 53 patients enrolled, 39 were evaluable at week 24. From baseline to week 24, 46 % of patients improved according to OMERACT-OARSI criteria. At week 24, there were improvements (all P < 0.05) in pain and function as assessed by WOMAC and M-SACRAH, and in pain interference, severity, and worst pain as assessed by BPI. Estradiol levels did not change from baseline. The most commonly reported side effects were headache (28 %), dyspepsia (15 %), and nausea (17 %). CONCLUSIONS:In this single-arm study, 24 weeks of glucosamine/chondroitin resulted in moderate improvements in AI-induced arthralgias, with minimal side effects, and no changes in estradiol levels. These results suggest a need to evaluate efficacy in a placebo-controlled trial.

背景与目标： 目的：许多患有激素受体阳性乳腺癌的妇女由于关节症状而停止有效的芳香化酶抑制剂（AI）治疗。
方法：我们进行了单臂，开放标签，II期研究，评估硫酸氨基葡萄糖（1,500毫克/天）硫酸软骨素（1200毫克/天）持续24周，以治疗绝经后早期女性的关节痛/僵硬启动AI后出现中度至重度关节痛的乳腺癌患者。主要终点是通过风湿病临床试验和国际骨关节炎研究协会（OMERACT-OARSI）标准中的结果评估标准评估的第24周疼痛/僵硬的改善。次要终点是使用西安大略省和麦克马斯特大学骨关节炎（WOMAC）指数评估臀部/膝盖的疼痛，僵硬和功能的变化，以及评估手的慢性类风湿病影响和量化的改良分数（M-SACRAH） / wrists。简短疼痛清单（BPI）评估了疼痛的干扰，严重程度和最严重的疼痛。
结果：在入组的53例患者中，有39例在第24周得到了评估。从基线到第24周，根据OMERACT-OARSI标准，有46％的患者得到了改善。在第24周时，WOMAC和M-SACRAH评估的疼痛和功能以及BPI评估的疼痛干扰，严重程度和最严重疼痛得到改善（所有P <0.05）。雌二醇水平与基线相比没有变化。最常见的副作用是头痛（28％），消化不良（15％）和恶心（17％）。
结论：在这项单臂研究中，葡萄糖胺/软骨素的24周可导致AI引起的关节痛适度改善，副作用最小，且雌二醇水平无变化。这些结果表明需要在安慰剂对照试验中评估疗效。

BACKGROUND & AIMS: :Obesity affects multiple points along the breast cancer control continuum from prevention to screening and treatment, often in opposing directions. Obesity is also more prevalent in Blacks than Whites at most ages so it might contribute to observed racial disparities in mortality. We use two established simulation models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the impact of obesity on race-specific breast cancer outcomes. The models use common national data to inform parameters for the multiple US birth cohorts of Black and White women, including age- and race-specific incidence, competing mortality, mammography characteristics, and treatment effectiveness. Parameters are modified by obesity (BMI of ≥ 30 kg/m(2)) in conjunction with its age-, race-, cohort- and time-period-specific prevalence. We measure age-standardized breast cancer incidence and mortality and cases and deaths attributable to obesity. Obesity is more prevalent among Blacks than Whites until age 74; after age 74 it is more prevalent in Whites. The models estimate that the fraction of the US breast cancer cases attributable to obesity is 3.9-4.5 % (range across models) for Whites and 2.5-3.6 % for Blacks. Given the protective effects of obesity on risk among women <50 years, elimination of obesity in this age group could increase cases for both the races, but decrease cases for women ≥ 50 years. Overall, obesity accounts for 4.4-9.2 % and 3.1-8.4 % of the total number of breast cancer deaths in Whites and Blacks, respectively, across models. However, variations in obesity prevalence have no net effect on race disparities in breast cancer mortality because of the opposing effects of age on risk and patterns of age- and race-specific prevalence. Despite its modest impact on breast cancer control and race disparities, obesity remains one of the few known modifiable risks for cancer and other diseases, underlining its relevance as a public health target.

背景与目标： 从肥胖症的预防到筛查和治疗，肥胖症通常会在相反的方向上影响着乳腺癌控制连续性的多个方面。在大多数年龄段，肥胖症在黑人中也比白人更为普遍，因此它可能导致观察到的种族差异。我们使用来自癌症干预和监视模型网络（CISNET）的两个已建立的仿真模型来评估肥胖对特定种族乳腺癌结果的影响。该模型使用共同的国家数据为美国多个黑人和白人妇女的出生队列提供参数，包括特定年龄和种族的发病率，竞争性死亡率，乳房X线照片特征和治疗效果。肥胖（BMI≥30 kg / m（2））及其特定于年龄，种族，队列和时间段的患病率会改变参数。我们测量年龄标准化的乳腺癌的发病率和死亡率，以及肥胖引起的病例和死亡。直到74岁，肥胖症在黑人中比白人更为普遍。 74岁以后，它在白人中更为普遍。这些模型估计，美国肥胖引起的乳腺癌病例中，白人的比例为3.9-4.5％（黑人），黑人的比例为2.5-3.6％（跨模型）。考虑到肥胖对<50岁女性的风险具有保护作用，在这个年龄段消除肥胖可能会增加两个种族的发病率，但会减少50岁以上女性的发病率。总体而言，在各模型中，肥胖分别占白人和黑人乳腺癌死亡总数的4.4-9.2％和3.1-8.4％。但是，由于年龄对风险和年龄和种族特定患病率的模式产生了相反的影响，因此肥胖患病率的变化对乳腺癌死亡率的种族差异没有净影响。尽管肥胖症对乳腺癌的控制和种族差异影响不大，但肥胖症仍然是为数不多的已知可改变的癌症和其他疾病风险之一，突显了肥胖症作为公共卫生目标的重要性。