18 research outputs found
Specificity of choline metabolites for in vivo diagnosis of breast cancer using 1H MRS at 1.5 T
No full textThe purpose was to determine if in vivo proton magnetic resonance spectroscopy ((1)H MRS) at 1.5 T can accurately provide the correct pathology of breast disease. Forty-three asymptomatic volunteers including three lactating mothers were examined and compared with 21 breast cancer patients. Examinations were undertaken at 1.5 T using a purpose-built transmit-receive single breast coil. Single voxel spectroscopy was undertaken using echo times of 135 and 350 ms. The broad composite resonance at 3.2 ppm, which includes contributions from choline, phosphocholine (PC), glycerophosphocholine (GPC), myo-inositol and taurine, was found not to be a unique marker for malignancy providing a diagnostic sensitivity and specificity of 80.0 and 86.0%, respectively. This was due to three of the asymptomatic volunteers and all of the lactating mothers also generating the broad composite resonance at 3.2 ppm. Optimised post-acquisitional processing of the spectra resolved a resonance at 3.22 ppm, consistent with PC, in patients with cancer. In contrast the spectra recorded for three false-positive volunteers, and the three lactating mothers had a resonance centred at 3.28 ppm (possibly taurine, myo-inositol or GPC). This improved the specificity of the test to 100%. Careful referencing of the spectra and post-acquisitional processing intended to optimise spectral resolution of in vivo MR proton spectra from human breast tissue resolves the composite choline resonance. This allows the distinction of patients with malignant disease from volunteers with a sensitivity of 80% and specificity of 100%. Therefore, resolution of the composite choline resonance into its constituent components improves the specificity of the in vivo (1)H MRS method, but does not overcome the problem of 20% false-negatives.Peter Stanwell, Laurence Gluch, David Clark, Boguslaw Tomanek, Luke Baker, Bruno Giuffrè, Cynthia Lean, Peter Malycha, Carolyn Mountfor
Breast conserving surgery: Adequate local clearance of the cancer is mandatory
No full textArticle first published online: 11 SEP 2009Peter L. Malych
Oncoplastic Breast Surgery: A Global Perspective on Practice, Availability, and Training
No full textBased on a BSI symposium, ISW 2007, Montreal, Canada.Oncoplastic surgery is the seamless joining of the extirpative and reconstructive aspects of breast surgery that is performed by a single surgeon. A symposium was held at ISW 2007 in Montreal with a prearranged aim to publish an article on the current and historical record of the developing specialty of oncoplastic breast surgery. The presenters and authors are well-known breast surgeons from Australia, Croatia, India, Sweden, and South Africa.Peter L. Malycha, Ian R. Gough, Marko Margaritoni, S. V. S. Deo, Kerstin Sandelin, Ines Buccimazza, Gaurav Agarwa
Age effects on survival from early breast cancer in clinical settings in Australia
No full textBACKGROUND: The study aim was to determine whether age is an independent risk factor for survival from early invasive breast cancer in contemporary Australian clinical settings. METHODS: The study included 31 493 breast cancers diagnosed in 1998–2005. Risk of death from breast cancer was compared by age, without and with adjustment for clinical risk factors, using Cox proportional hazard regression. RESULTS: Risk of breast cancer death was elevated for cancers of larger size, higher grade, positive nodal status, oestrogen receptor negative status, vascular invasion and multiple foci. Ductal lesions presented a higher risk than other lesions. Adjusting for these factors, the relative risk of breast cancer death (95% confidence limits) was lower for 40–49-year-olds at 0.80 (0.66, 0.96) than for the reference category under 40 years, but higher for 70–79-year-olds at 1.64 (1.36, 1.98) and women aged 80 years or more at 2.19 (1.79, 2.69). The risk for 50–69-year-olds and women under 40 years was similar. Risk-factor adjustment reduced the difference in risk between the reference category under 40 years and 40–49-year-olds, largely eliminated the lower relative risk for 50–69-year-olds, and increased the relative risks for women aged 70–79 years and older. DISCUSSION: Survivals in women under 40 and over 70 years of age are poorer than for 40–69-year-olds. Research is needed into the best treatment modalities for younger women and older women with co-morbidity.David M. Roder, Primali de Silva, Helen M. Zorbas, James Kollias, Peter L. Malycha, Chris M. Pyke and Ian D. Campbel
Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status
No full textOBJECTIVE: Early invasive breast cancer data from the Australian National Breast Cancer Audit were used to compare case fatality by surgeon case load, treatment centre location and health insurance status. METHOD: Deaths were traced to 31 December 2007, for cancers diagnosed in 1998–2005. Risk of breast cancer death was compared using Cox proportional hazards regression. RESULTS: When adjustment was made for age and clinical risk factors: (i) the relative risk of breast cancer death (95% confidence limit) was lower whensurgeons’ annual case loads exceeded 20 cases, at 0.87 (0.76, 0.995) for 21–100 cases and 0.83 (0.72, 0.97) for higher case loads. These relative risks were not statistically significant when also adjusting for treatment centre location (P_0.15); and (ii) compared with major city centres, inner regional centres had a relative risk of 1.32 (1.18, 1.48), but the risk was not elevated for more remote sites at 0.95 (0.74, 1.22). Risk of death was not related to private insurance status. CONCLUSION: Higher breast cancer mortality in patients treated in inner regional than major city centres and in those treated by surgeons with lower case loads requires further study.David Roder, Primali de Silva, Helen M. Zorbas, James Kollias, Peter L. Malycha, Chris M. Pyke and Ian D. Campbel
Breast tissue lipid and metabolite deregulation precedes malignant transformation in women with BRCA gene mutations: A longitudinal study
No full textWomen carrying the <i>BRCA1</i> and <i>BRCA2</i> gene mutations exhibited lipid and metabolite profiles consistent with very early deregulation recorded earlier in cancer cell models. The deregulation was different for BRCA1 and BRCA2. Here we report a longitudinal study where these same women are monitored every six month using the <i>L-COSY MRS</i> method and every 12 month with contrast enhanced MRI. For most women in the study the biomarkers remained relatively stable over time. Of the 6 <i>BRCA1</i> and 10 <i>BRCA2</i> patients examined, one <i>BRCA1</i> patient and one <i>BRCA2</i> patient showed further deregulatio
Alterations to breast tissue chemistry in women at risk of cancer: 2D MR spectroscopy in vivo study
No full textIn vivo 2D L-COSY identifies premalignant changes in women at high risk of developing breast cancer that are not seen by routine imaging, and allows women to be identified as MR spectroscopy Low Risk or MR spectroscopy High Risk according to changes recorded. Changes in the MR spectroscopy High Risk group include deregulation of lipid pathways and increased levels of metabolites. If these changes are confirmed in larger populations, it is possible that this information will allow women at increased clinical risk for breast cancer an objective means to monitor changes that may be taking place in their breast tissue
Lipid deregulation in women carrying the BRCA mutations: Non invasive evaluation by two-dimensional spectroscopy
No full text<i>BRCA1</i> and <i>BRCA2</i> genes belong to the tumor suppressor family and patients with these genes are at increased risk of developing breast cancer. A <i>BRCA1</i> or <i>BRCA2</i> mutation carrier has approximately a 3% risk of getting breast cancer before the age of 30. However, this risk increases to almost 50% when the patient reaches the age of 50 and becomes 50%-80% at the age of 70. <i>BRCA2</i> mutation carriers have been shown to survive longer than those carrying BRCA1 mutations. This difference has been attributed to increased ovarian deaths in <i>BRCA1</i> mutation carriers. In this study, we apply in vivo two-dimensional 2D localized correlation spectroscopy (<i>L-COSY</i>) to look for a premalignant state in the breast tissues of apparently healthy women carrying the <i>BRCA</i> gene mutations and others with a family history. We propose the hypothesis that those with the <i>BRCA</i> gene mutations would have altered chemistry reflective of a preinvasive state
Clinician-performed ultrasound in assessing potentially malignant thyroid nodules
No full textBackground: Ultrasound (US) is used in the workup of thyroid nodules. Ultrasonographic characteristics, such as an ill-defined margin, hypoechoicity or fine calcifications, are known to be associated with malignant thyroid lesions. The association between these characteristics and the risk of malignancy has been reported predominantly from series published where US is performed in radiology departments. Clinician-performed ultrasound (CPU) is increasingly being used as a modality, although there is little published literature validating this practice. Method: A prospectively collected database of known ultrasonographic characteristics of malignancy as determined by CPU on thyroid nodules is reported and correlated against adequate cytology or operative histopathology. Results: In total, 157 thyroid nodules (28 malignant, 129 benign) were included and characteristics of poorly defined capsule (sensitivity 46%, specificity 91%), absence of halo (sensitivity 54%, specificity 80%), hypoechoicity (sensitivity 79%, specificity 54%), heterogeneity (sensitivity 64%, specificity 68%), fine calcifications (sensitivity 36%, specificity 95%) and central blood supply (sensitivity 71%, specificity 69%) were found to be associated with malignant thyroid nodules. Negative-predictive values (NPVs) for these characteristics were consistently high (89%, 89%, 92%, 90%, 87% and 94%, respectively). Discussion: These results are consistent with the previously published datasets of ultrasonographic characteristics of malignancy and validate the use of CPU. The consistently high NPV suggests that the absence of ultrasonographic characteristics of malignancy correlates well with benign lesions. CPU is a reliable and useful tool in the hands of surgeons assessing and following potentially malignancy thyroid nodules.Peter W. Hamer, Sebastian R. Aspinall and Peter L. Malych
