Evaluation of total choline from in-vivo volume localized proton MR spectroscopy and its response to neoadjuvant chemotherapy in locally advanced breast cancer.

Results of the proton magnetic resonance spectroscopy carried out on normal, benign breast disease and locally advanced breast cancer patients are presented. The in-vivo MR spectra of malignant breast tissue of patients (n = 67) suffering from infiltrating ductal carcinoma are dominated by the water resonance, while the spectra of the unaffected contralateral breast tissue of these patients are mainly dominated by resonance arising from lipids which is similar to the spectra of normal breast tissue obtained from volunteers (controls, n = 16). In addition to the water and lipid peaks, in majority of the patients (approximately 80%) the water suppressed spectra showed a resonance at 3.2 ppm due to choline containing compounds (TCho) before treatment. In patients receiving neoadjuvant chemotherapy, absence/reduction in choline was observed in 89% of the patients. TCho was also observed in 2 of 14 benign lesions. The sensitivity and specificity of in-vivo MRS in detecting TCho in malignant tumours was 78% and 86%, respectively. Observation of TCho before treatment and its disappearance (or reduction) after treatment may be a useful indicator of response of locally advanced breast cancer to neoadjuvant chemotherapy.

Volume localized in vivo proton MR spectroscopy of breast carcinoma: variation of water-fat ratio in patients receiving chemotherapy.

Results are reported on in vivo volume localized proton magnetic resonance spectroscopy (MRS) of patients (n = 44) suffering from carcinoma of the breast, using a bilateral breast surface coil. Localized proton MR spectra of the unaffected contralateral breast of these patients are dominated by resonances arising from fat and are similar to the breast tissue from normal volunteers (controls, n = 13), while in the malignant breast tissues the water resonance dominates. On the other hand, the water suppressed proton MR spectra of malignant breast tissue reveal several metabolites of low concentration including the choline peak around 3.2 ppm and other resonances attributable to purine and pyrimidine nucleotides, in the 8.5 ppm region. Elevated water- fat (W-F) ratios are measured in the malignant tissues, compared with the normal breast tissue of controls and from the contralateral unaffected breast tissue of the patients (n = 11). In the case of patients receiving chemotherapy resulting in the reduction of primary tumor size, the W-F ratio shows a statistically significant (P < 0.01) decrease compared with the pre-therapy value, thus providing a non-invasive indicator of favourable clinical outcome of neoadjuvant chemotherapy for locally advanced breast cancer. The method provides the potential for non-invasively monitoring and assessing the response of breast cancer to neoadjuvant chemotherapy.

A new incision for intra-oral access without lip split.

A non-lip-splitting approach to the oral cavity is described, using a curved incision through the angle of the mouth along the inferior buccolabial sulcus. The incision provides good access to the entire oral cavity and heals efficiently with good cosmetic results. It is suited to patients who require excision of the oral commissure.