Effects of cluster size on trypophobic discomfort in children aged 4-9 years.

It has been reported that strong discomfort associated with clusters of circles and holes (trypophobia), including lotus pod seeds, manifests in individuals as young as 4 or 5 years old. This study investigated how the size and number of circles within clusters affected discomfort levels in adults and in children aged 4-9 years. In Experiment 1, we confirmed that the remote experimental procedure could evoke discomfort when participants were presented with cluster images. The findings reveal that children as young as 4 or 5 years old consistently experienced discomfort when rating trypophobic images, even printed images rated in real time during video calls. In Experiment 2, we explored the impact of cluster size, considering both the size and number of circles, in a remote experiment. The results indicate that discomfort tended to increase with cluster size in both children and adults, with the effect becoming more pronounced with age.

[A Case of Axillary Accessory Breast Cancer Treated via Latissimus Dorsi Musculocutaneous Flap Reconstruction].

A 46-year-old woman visited our hospital with the chief complaint of left axillary mass enlargement, which she had been aware of for 8 years. Palpation revealed that the mass was 15mm in size. Redness and gathering of the skin were also observed. Mammographic imaging of the left axilla revealed an irregular mass with skin infiltration. Breast ultrasonography revealed a low echo mass in the left axilla, which was continuous from the skin. Core needle biopsy was used to diagnose the tumor as an invasive ductal carcinoma. No other lesions were observed in the breast, and primary lesions were not found in any other organs. The patient was diagnosed with axillary accessory breast cancer and underwent local extensive resection and axillary lymph node dissection. Because the skin defect was widespread, we performed axillary reconstruction using the latissimus dorsi musculocutaneous flap to prevent upper limb contracture. At present, she can move her upper limbs and lymphedema has not been observed. In cases of axillary accessory breast cancer with skin infiltration, reconstruction using the latissimus dorsi musculocutaneous flap can be a useful procedure.

Diagnostic performance of time-of-flight PET/CT for evaluating nodal metastasis of the axilla in breast cancer.

OBJECTIVE: The aim of this study was to evaluate the performance of preoperative axillary lymph node assessment in breast cancer using time-of-flight 18F-fluorodeoxyglucose PET/computed tomography (TOF [F-18]FDG-PET/CT). METHODS: Eighty-two women with breast cancer (mean age, 59.3 years; range, 30-84 years) underwent TOF [F-18]FDG-PET/CT scanning before surgery between January 2016 and June 2018 at our hospital. Visual analysis of FDG uptake and the maximum standardized uptake value (SUVmax) of axillary lymph nodes were compared with the pathological diagnoses. RESULTS: There were 77 patients with invasive breast carcinoma (mean invasive long diameter, 18.5 mm; range, 2-90 mm) and five patients with noninvasive carcinoma. Axillary lymph node metastases were histologically confirmed in 13 of 82 patients (15.9%). SUVmax showed an area under a receiver operating characteristic curve of 0.916, and the cut-off value of 1.1 was appropriate. By visual assessment, there were 11 true positives, 15 false positives, 54 true negatives and two false negatives; the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85%, 78%, 42%, 96% and 79%, respectively. SUVmax showed values of 69%, 99%, 90%, 94% and 94%, respectively. CONCLUSIONS: The sensitivity of TOF [F-18]FDG-PET/CT was as high as 85% by visual analysis. SUVmax using TOF [F-18]FDG-PET/CT showed high diagnostic performance for N-staging in breast cancer patients, especially high negative predictive value. The specificity, positive predictive value and accuracy of SUVmax were higher than those of visual analysis.

Simultaneous comparison between strain and shear wave elastography of breast masses for the differentiation of benign and malignant lesions by qualitative and quantitative assessments.

PURPOSE: To compare the addition of diagnostic strain elastography (SE) and shear wave elastography (SWE) values to the conventional B-mode ultrasonography in differentiating between benign and malignant breast masses by qualitative and quantitative assessments. MATERIALS AND METHODS: B-mode ultrasound, SE, and SWE were simultaneously performed using one ultrasound system in 148 breast masses; 88 of them were malignant. The breast imaging reporting and data system category in the B-mode, Tsukuba score (SETsu), Fat-Lesion-Ratio (SEFLR) in SE, and five-point color assessment (SWEcol) and elasticity values (SWEela) in SWE were assessed. The results were compared using the area under the receiver-operating characteristic curve (AUC). RESULT: The AUC for B-mode and each elastography were similar (B-mode, 0.889; SETsu, 0.885; SEFLR, 0.875; SWEcol, 0.881; SWEela, 0.885; P > 0.05). The combined sets between B-mode and either of the elastography technique showed good diagnostic performance (B-mode + SETsu, 0.903; B-mode + SEFLR, 0.909; B-mode + SWEcol, 0.919; B-mode + SWEela, 0.914). B-mode + SWEcol and B-mode + SWEela showed a higher AUC than B-mode alone (P = 0.026 and 0.029), and B-mode + SETsu and B-mode + SEFLR showed comparable AUC to B-mode alone (P = 0.196 and 0.085). There was no significant difference between qualitative and quantitative assessments for the combined sets of B-mode and elastography (P > 0.05). CONCLUSION: The addition of both SE and SWE to B-mode ultrasound improved the diagnostic performance with increased AUC, and especially SWE was more useful than SE, and no significant difference was found between qualitative and quantitative assessments.

Distinction between benign and malignant breast masses at breast ultrasound using deep learning method with convolutional neural network.

PURPOSE: We aimed to use deep learning with convolutional neural network (CNN) to discriminate between benign and malignant breast mass images from ultrasound. MATERIALS AND METHODS: We retrospectively gathered 480 images of 96 benign masses and 467 images of 144 malignant masses for training data. Deep learning model was constructed using CNN architecture GoogLeNet and analyzed test data: 48 benign masses, 72 malignant masses. Three radiologists interpreted these test data. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS: The CNN model and radiologists had a sensitivity of 0.958 and 0.583-0.917, specificity of 0.925 and 0.604-0.771, and accuracy of 0.925 and 0.658-0.792, respectively. The CNN model had equal or better diagnostic performance compared to radiologists (AUC = 0.913 and 0.728-0.845, p = 0.01-0.14). CONCLUSION: Deep learning with CNN shows high diagnostic performance to discriminate between benign and malignant breast masses on ultrasound.

Clinicopathological relevance of kinesin family member 18A expression in invasive breast cancer.

Recently, kinesin motor proteins have been focused on as targets for cancer therapy. Kinesins are microtubule-based motor proteins that mediate diverse functions within the cell, including the transport of vesicles, organelles, chromosomes and protein complexes, as well as the movement of microtubules. In the current study, the expression of kinesin family member 18A (KIF18A), a member of kinesin superfamily, was investigated in breast cancer using immunohistochemistry, and its effect on breast cancer prognosis was examined. KIF18A expression level was significantly associated with lymph node metastasis (P=0.047). In patients with high levels of KIF18A expression, survival was significantly poorer compared to patients with low levels of KIF18A expression (disease-free survival, P=0.030). Multivariate analysis revealed that venous invasion (hazard ratio, 9.22; 95% confidence interval, 3.90-23.66; P<0.001) and KIF18A expression (hazard ratio, 3.20; 95% confidence interval, 1.34-6.09; P=0.010) were independent predictive factors for lymph node metastasis. KIF18A may be a useful predictive marker for lymph node metastasis in breast cancer, which could facilitate curative adjuvant treatment.

Efficiency of fluorodeoxyglucose positron emission tomography/computed tomography to predict prognosis in breast cancer patients received neoadjuvant chemotherapy.

Neoadjuvant chemotherapy (NAC) has become a standard therapy for patients with advanced breast cancer. Pathological complete response (pCR) after NAC is an important prognostic indicator, but some patients with pCR continue to experience recurrence. So new predictive and prognostic markers in addition to pCR are needed following NAC for breast cancer. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can evaluate metastases in the entire body simultaneously, and has several potential advantages over conventional imaging modalities. The purpose of this study was to evaluate whether FDG-PET/CT can determine NAC response and whether FDG-PET/CT can be a new prognostic marker. We imaged 83 breast cancer tumors with FDG-PET/CT, ultrasound (US), and magnetic resonance imaging (MRI) to evaluate NAC efficacy. As we previously analyzed 110 breast cancers with FDG PET/CT, we defined a threshold of >1.7 maximum standardized uptake value (SUVmax) as abnormal fluorodeoxyglucose (FDG) uptake. After NAC, 16 (19.3 %) tumors had a complete response, 54 (65.1 %) had a partial response, 11 (13.3 %) showed stable disease, and 2 (2.4 %) showed progressive disease. One of the two patients with progressive disease had bone metastasis detected by FDG-PET/CT and was not operated on. Remote metastases were evident in 2.4 % of patients after NAC as determined by FDG-PET/CT. Overall, 17 patients had pathological complete response (pCR). The sensitivity of abnormal FDG uptake after NAC for non-pCR was 20.3 % and the specificity was 94.7 %. Patients with abnormal FDG uptake after NAC experienced significantly more recurrences (P = 0.004) and more of them died (P = 0.010). Moreover, the difference in disease-free survival was more significant in the estrogen receptor (ER)-negative group. FDG-PET after NAC may be more effective for predicting prognosis than for evaluating treatment response. This tendency was particularly remarkable in ER-negative breast cancer tumors. FDG-PET/CT is useful for reevaluating surgical applicability after NAC.

[A case of cardiac tamponade due to breast cancer treated with weekly paclitaxel].

A 44-year-old woman who underwent surgery for left breast cancer 2 years ago presented with dyspnea. Her pathological stage of breast cancer was T2N1M0, ER (3+), PgR (3+), and HER2: 1+. She was treated with tamoxifen only as adjuvant therapy. Pleural effusion in both lungs and pericardial effusion were detected by computed tomography. We aspirated 1,100 mL of the pleural effusion and 700 mL of the pericardial effusion; the cytologies of both were class V. Because her dyspnea disappeared, she was administered weekly paclitaxel. Her pleural effusion and pericardial fluid have not re- emerged. The therapy of choice for pericardial effusion is local chemotherapy or systemic chemotherapy. Systemic chemotherapy after pericardial drainage was effective for this patient. Key words: Breast cancer.

[A long-surviving case of HER2-positive breast cancer with brain metastasis treated by multidisciplinary therapy].

We present a case of a 55-year-old woman who visited our hospital aware of a lump in her right breast. We diagnosed it as bilateral breast cancer [Rt: ABCDE, T3N1M0, ER (-), PgR (-), HER2: 3+, Stage IIIA; Lt: C, T2N0M0, ER (-), PgR (-), HER2: 1+, Stage IIA]. She underwent NAC with EC followed by docetaxel. After cPR, an operation (Rt Bt+Ax, Lt Bp+Ax) was performed. Liver metastases were identified 9 months after the operation, and she was administered weekly paclitaxel+trastuzumab for 12 courses. After cPR, the treatment was changed to trastuzumab only. Because a cerebellar metastasis appeared in postoperative month 19, she underwent an operation using a gamma-knife. Because a new cerebellar metastasis appeared in postoperative month 26, she underwent another gamma-knife operation. Furthermore, liver metastases were diagnosed as PD, and treatment was changed to vinorelbine and trastuzumab. Because third new cerebellar metastasis appeared in postoperative month 45, she underwent another gamma-knife operation. Lung metastases were identified 59 months after the operation, and the therapy was changed to lapatinib and capecitabine. There was no subsequent growth of metastatic tumors, and good control was obtained.

[A case of metastatic breast cancer with bilateral hydronephrosis effectively treated with capecitabine].

A 54-year-old female was diagnosed with invasive ductal carcinoma (pT3N1M0, Stage IIIA, estrogen receptor positive [ER (+)], progesterone receptor positive [PgR (+)], human epidermal growth factor receptor type 2 [HER2] score 0) and was treated by preoperative chemotherapy with weekly paclitaxel followed by 5-fluorouracil(5-FU) plus epirubicin plus cyclophosphamide regimen(FEC). Partial mastectomy with axillary dissection was performed. The pathological examination disclosed that the tumor was scirrhous carcinoma, and a pathological partial response was achieved by chemotherapy. Multiple bone metastases were detected 18 months after the surgery during treatment with letrozole as adjuvant therapy. Retroperitoneal metastases with hydronephrosis and a lung metastasis were detected 28 months after the surgery, even though exemestane and zoledronate were administrated after detection of the bone metastases. Chemotherapy with capecitabine was started and she recovered from hydronephrosis 4 months after the start of treatment. After 32 months from the first treatment with capecitabine, the patient is presently alive without hydronephrosis due to continued chemotherapy.