Katsumi Ikeda

Osaka City General Hospital, Ōsaka, Ōsaka, Japan

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Publications (19)30.1 Total impact

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    ABSTRACT: Background: Neo-adjuvant chemotherapy(NAC)may affect hormone receptor(HR)and human epidermal growth factor receptor 2(HER2)status in breast cancer patients. However, the correlation between recurrence rates and this status change remains unclear. Methods: We evaluated 70 consecutive breast cancer patients receiving NAC with anthracyclines and taxanes, with or without trastuzumab, between January 2005 and May 2012. Pre-treatment core needle biopsy samples and specimens obtained after surgery were tested to determine HR and HER2 status. The relationship between HR and HER2 status changes and recurrence rates was then assessed. Results: Pathological complete response(pCR)was observed in 13 cases and non-pCR was observed in 57 cases. Of the non-pCR cases, HR-positive status changed to HR-negative status in 6.3% of patients, but a change from negativity to positivity was not observed. HER2-positive status changed to HER2-negative status in 48.0% of patients, and a change from negativity to positivity was observed in 12.5% of cases. The recurrence rate among patients with conversion to a HR-negative status was 0%and that among patients with conversion to a HER2-negative status was 25.0%. Conclusion: Recurrence rates were not significantly associated with HR and HER2 status conversion after NAC. Future research is warranted to confirm out results.
    Gan to kagaku ryoho. Cancer & chemotherapy 03/2014; 41(3):313-6.
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    ABSTRACT: Various techniques are used for sentinel lymph node biopsy (SLNB) in breast cancer. While subareolar injection with dye alone is a relatively easy method, few studies have reported the outcome with a follow-up period. This study presents our results of SLNB using dye alone. Between November 2002 and December 2010, 701 patients with breast cancer underwent SLNB using subareolar injection of indocyanine green or indigo carmine. Sentinel lymph node (SLN)-negative patients were followed without axillary lymph node dissection (ALND). SLNs were detected in 654 of 701 patients (93.3 %), and the rate increased to 98.1 % over the course of the study. The mean number of SLNs removed was 1.5. There was no significant difference in the detection rate between two dyes. No adverse events resulted from the injection of dyes. Of the 654 patients, 136 (20.8 %) had SLN metastasis. Five hundred patients were followed without ALND. Thirty-six patients experienced disease relapse during a median follow-up of 60 months. Thirteen patients (2.6 %) had regional lymph node relapse, and eight of them could undergo salvage lymph node dissection. The 5-year disease-free and overall survival rates were 92.4 and 96.1 %, respectively. SLNB using subareolar injection with dye alone was safe and feasible even after a long follow-up.
    Surgery Today 09/2013; · 0.96 Impact Factor
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    ABSTRACT: BACKGROUND: Axillary reverse mapping (ARM) is a new technique to preserve upper extremity lymphatic pathways during axillary lymph node dissection (ALND), thereby preventing lymphedema patients with breast cancer. However, the oncologic safety of sparing the nodes identified by ARM (ARM nodes), some of which are positive, has not been verified. We evaluated the metastatic status of ARM nodes and the efficacy of fine needle aspiration cytology (FNAC) in assessing ARM node metastasis. METHODS: Sixty patients with breast cancer who underwent ARM during ALND between January 2010 and July 2012 were included in this study. Twenty-five patients were clinically node-positive and underwent ALND without sentinel lymph node biopsy (SLNB). Thirty-five patients were clinically node-negative but sentinel node-positive on the SLND. The lymphatic pathway was visualized using fluorescence imaging with indocyanine green. ARM nodes in ALND field, whose status was diagnosed using FNAC, were removed and processed for histology. We evaluated the correlation between the cytological findings of FNAC and the histological analysis of excised ARM nodes. RESULTS: The mean number of ARM nodes identified per patient was 1.6 +/-0.9 in both groups. In most patients without (88%) and with (79%) SLNB, the ARM nodes were located between the axillary vein and the second intercostobrachial nerve. FNAC was performed for 45 ARM nodes, 10 of which could not be diagnosed. Six of the patients without SLNB (24%) and onewith SLNB (3%) had positive ARM nodes. Of these sevenpatients, four had >3 positive ARM nodes. There was no discordance between the cytological and histological diagnosis of ARM nodes status. CONCLUSIONS: Positive ARM nodes were observed in the patients not only with extensive nodal metastasis but also in those with a few positive nodes. FNAC for ARM nodes was helpful in assessing ARM nodes metastasis, which can be beneficial in sparing nodes essential for lymphatic drainage, thereby potentially reducing the incidence of lymphedema. However, the success of sampling rates needs to be improved.
    World Journal of Surgical Oncology 11/2012; 10(1):233. · 1.09 Impact Factor
  • Katsumi Ikeda, Yoshinari Ogawa
    Breast Cancer 06/2012; · 1.33 Impact Factor
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    ABSTRACT: BACKGROUND: Guidelines for breast cancer patient follow-up have not been widely adopted in Japan. To assess our intensive follow-up program, we evaluated first relapse and its indicators in patients with breast cancer. PATIENTS: Of 964 patients, 126 relapsed and 43 died in the median follow-up term of 45 months. Follow-ups were scheduled every 6-12 months for imaging and tumor marker (TM) evaluation. RESULTS: Of 126 relapsed patients, 30 (23.8%) had symptoms of relapse. First indicators of relapse in 96 asymptomatic patients were physical examination in 24 patients (19%); imaging, 57 patients (45.3%); and TMs, 15 patients (11.9%). The most sensitive indicators were physical examination for local relapse, ultrasonography for regional lymph nodes, scintigraphy for bone, computed tomography for lung, and TMs for liver metastasis. During intensive follow-up, 43% of relapsed patients were identified by symptoms or physical examination. These patients had poor prognosis compare to patients identified by imaging or TMs in overall survival and post-relapse survival (p = 0.009 and 0.019, respectively). In all 964 patients, the relapse rates for stage I, IIA, IIB, and III tumors were 7.4, 7.9, 19.9, and 43.5%, respectively. The percentage of first relapse detected by imaging or TMs for stage I, IIA, IIB, and III were 4.7, 5.1, 11.8, and 19.8%, respectively. The cost of our follow-up program for 10 years was approximately 290,000 yen per patient. CONCLUSION: A routine intensive follow-up program involving imaging and evaluation of TMs in all patients has low efficacy and high expenditure.
    International Journal of Clinical Oncology 03/2012; · 1.41 Impact Factor
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    ABSTRACT: A 23-year-old woman was admitted with complaints of swelling and pain in the left breast, fever, polyarthralgia and erythema nodosum. A fine-needle biopsy of the mass in the left breast revealed non-caseous granulomatous lobulitis. A diagnosis of granulomatous mastitis was thus made. The administration of prednisolone 40 mg/day resulted in the resolution of the patient's symptoms, and the breast mass thereafter decreased in size. The mass relapsed during the subsequent prednisolone taper. Additional therapy with methotrexate resulted in complete remission. Granulomatous mastitis should therefore be included in the differential diagnosis of polyarthralgia.
    Internal Medicine 01/2012; 51(20):2957-60. · 0.97 Impact Factor
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    ABSTRACT: Triple-negative breast cancer (TNBC), which is characterized by negativity for estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2), is a high risk breast cancer that lacks specific targets for treatment selection. Chemotherapy is, therefore, the primary systemic modality used in the treatment of this disease, but reliable parameters to predict the chemosensitivity of TNBC have not been clinically available. A total of 190 TNBC patients who had undergone a curative resection of a primary breast cancer were enrolled. The adjuvant chemotherapy was performed for 138 (73%) of 190 TNBC cases; 60 cases had an anthracyclin-based regimen and 78 a 5-fluorouracil-based regimen. The prognostic value of E-cadherin, Ki67 and p53 expression in the outcome of TNBC patients with adjuvant chemotherapy was evaluated by immunohistochemistry. The adjuvant therapy group, especially those with Stage II TNBC, had a more favorable prognosis than the surgery only group (P = 0.0043), while there was no significant difference in prognosis between the anthracyclin-based regimen and 5-fluorouracil-based regimen. Patients with E-cadherin-negative and Ki67-positive expression showed significantly worse overall survival time than those with either E-cadherin-positive or Ki67-negative expression (P < 0.001). Multivariate analysis showed that the combination of E-cadherin-negative and Ki67-positive expression was strongly predictive of poor overall survival (P = 0.004) in TNBC patients receiving adjuvant chemotherapy. In contrast, p53 status was not a specific prognostic factor. Adjuvant therapy is beneficial for Stage II TNBC patients. The combination of E-cadherin and Ki67 status might be a useful prognostic marker indicating the need for adjuvant chemotherapy in Stage II TNBC patients.
    Breast cancer research: BCR 11/2011; 13(6):R122. · 5.87 Impact Factor
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    ABSTRACT: The role of elastography for breast tumors is still ambiguous. The purpose of this study was to inquire how effectively elastography can be used in the diagnosis of breast tumors. The fat lesion ratio (FLR) of 244 lesions (99 malignant and 145 benign lesions) was calculated using tissue Doppler imaging with elastography. The pathological confirmations were performed by core needle or excisional biopsy. Conventional ultrasonography (US) findings were classified according to the Breast Imaging Reporting and Data System. We tried to set the region of interest (ROI) at the hardest area of the target and measured the maximum FLR (max-FLR) of the target with elastography, whereas the control ROI was placed in the subcutaneous adipose tissue. The diagnostic potential of the max-FLR combined with the US category was evaluated. The mean max-FLR of malignant lesions was significantly greater than that of benign lesions, at 11.0 and 4.4, respectively (p < 0.01). The max-FLR showed a wide overlap range between benign and malignant lesions, but there were no malignant lesions showing a less than 2.0 max-FLR. Ninety-six percent of the lesions interpreted as category 3 were benign, and the negative predictive value measuring the max-FLR was kept at 98% as long as the max-FLR was less than 4.0. Measuring the max-FLR may reduce unnecessary biopsies by 57.5% in the category 3 group. Combining conventional US categories and measuring max-FLR with elastography may be helpful in reducing the number of unnecessary biopsies in category 3 lesions.
    Breast Cancer 05/2011; 19(1):71-6. · 1.33 Impact Factor
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    ABSTRACT: To evaluate the liaison-clinical pathway for patients with breast cancer introduced since May 2008, the data from a questionnaires survey of 56 clinics and 105 patients were reviewed. Half of the clinics specialized in internal medicine. 93% of physicians recognized the utility of the pathway while 24% made the most of the pathway. About 40% of the clinics wished to enlarge both the patient number and treatment materials. Half of the patients were employed. 55% of patients valued the pathway as helpful. And 29% of patients used the patient booklet at all times. 8% of patients replied they had complaints went to clinics. There has been no serious problem in using the pathway. Countermeasures to electronic health records in clinics, and responses to requests from each patient will be needed.
    Gan to kagaku ryoho. Cancer & chemotherapy 08/2010; 37(8):1477-81.
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    ABSTRACT: LH-RH agonist is the key drug in hormonal therapy for premenopausal patients with breast cancer. It is important to reduce the pain related to injecting the LH-RH agonist, because patients must continue the medication for several years. We developed a way to reduce the pain by cooling the needle injecting site with a frozen ice pack. 18 premenopausal postoperated women filled out a questionnaire on the severity of pain upon injecting Goserelin acetate compared with the pain without this cooling method and pretreatment. We estimated the pain by a Numerical Rating Scale(NRS). The NRS scores of this cooling method revealed the pain to be significantly less than by control method(p<0. 005). This cooling method could be useful for the reduction of pain upon injecting the LH-RH agonist.
    Gan to kagaku ryoho. Cancer & chemotherapy 02/2010; 37(2):291-3.
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    ABSTRACT: A liaison-clinical pathway for patients with stage I to III breast cancer undergoing adjuvant oral chemoendocrine therapy after curative operation has been introduced in our hospital since May of 2008. The form of this pathway was developed from the former cooperative treatment system between our hospital and local clinics. One hundred thirty four patients and 69 clinics have been using this pathway for 6 months. Our liaison-clinical pathway consists of a chart for the clinic-doctor, a leaflet with a checklist for the patient, and supplements. The aim of this pathway was care for patients with breast cancer in addition to total health care in a local clinic. Our pathway decreased patient anxiety and facilitated clinic-doctor acceptance for the cooperative cancer treatment system. A coordinator is a key person who constructs and manages this pathway. There has been no trouble in managing the pathway for 6 months. The liaison clinical pathway will be useful to reduce patient burden while maintaining treatment quality.
    Gan to kagaku ryoho. Cancer & chemotherapy 08/2009; 36(7):1115-8.
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    ABSTRACT: Breast cancer is a hormone-dependent tumor. Most breast cancer cells have an androgen receptor (AR), but the clinical value of AR expression is unclear. AR expression was evaluated in 227 primary breast cancers using immunohistochemistry. The relation of AR expression to clinicopathological factors and biomarkers was analyzed. AR expression was assessed semiquantitatively, and tumors with more than 10% of stained cells were regarded as positive. The AR-positive rate was higher in smaller tumors (P=0.045), tumors with negative lymph node metastasis (P=0.045), scirrhous-type tumors (P<0.0001), tumors of low histological grade (P=0.0001), and p53-negative tumors (P = 0.0097). Although AR had no relation to menopausal status, 79% of cases of high AR expression (>50% stained cells) were in postmenopausal women. AR was related to estrogen receptor (ER; P=0.027) and progesterone receptor (PR; P=0.016) expression, but showed no relation to human epidermal growth factor receptor type 2 (Her2) expression. Regarding the coexpression of these receptors, 18 of the 42 cases of triple-negative (ER/PR/Her2-negative) tumors (43%) were AR-positive. AR expression is related to low malignancy in breast cancer. The assessment of AR expression may lead to new treatment strategies for breast cancer, especially in postmenopausal women and in women with tumors that show triple negativity for hormone receptors.
    International Journal of Clinical Oncology 10/2008; 13(5):431-5. · 1.73 Impact Factor
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    ABSTRACT: Breast carcinomas contain both tumor cells and stromal cells, including fibroblasts, endothelial cells, and lymphocytes. Proliferation of breast cancer cells may be controlled partly by mesenchymal cells, especially fibroblasts. We studied effects of fibroblasts on tumorigenicity and histologic features of breast cancer cells vivo, and analyzed fibroblast-produced growth-promoting factors in vitro. Breast carcinoma cells from four lines, and fibroblasts from lines obtained from skin and breast tissue of four patients with breast cancer were used. A suitable number of breast tumor cells and fibroblasts were inoculated subcutaneously into nude mice; resulting tumors were examined. Then conditioned medium from fibroblasts was added to cultures of breast cancer cells to study growth effects, and growth-promoting factors from breast fibroblasts were analyzed. Co-inoculation of breast cancer cells with breast fibroblasts into mice significantly increased tumorigenicity and tumor size beyond those obtained with breast cancer cells alone. Histologically, tumors resulting from co-inoculation with breast fibroblasts showed a scirrhous pattern with extensive fibrosis, while those formed by breast cancer cells injected alone or co-inoculation with skin fibroblasts showed a solid pattern. Medium from breast fibroblasts significantly increased breast cancer cell growth in vitro, while the various skin fibroblasts did not all show this effect. Structural and functional interactions between organ-specific fibroblasts and breast cancer cells may importantly regulate breast cancer growth and progression.
    Breast Cancer Research and Treatment 05/2005; 90(3):307-13. · 4.47 Impact Factor
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    ABSTRACT: From 1994 until 2002, we performed 6956 ultrasonic screenings of the thyroid for all patients who received breast examination by ultrasonography. We discovered 14 thyroid cancers (0.32%) from 4327 cases with breast complaints. The incidence of thyroid cancer with breast cancer (0.25%) was three times higher than that of thyroid cancer without breast cancer (0.73%). It was concluded that ultrasonic screening of the thyroid was useful in patients with breast complaints.
    01/2005;
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    ABSTRACT: BackgroundAn immunohistochemical (IHC) method is commonly used for determining estrogen receptor (ER) and progesterone receptor (PR) status in breast cancer. However, the proper cut-off points of IHC have not been established. Cut-off points for ER and PR status as predictive factors for endocrine therapy are needed. MethodsA total of 249 cases of female breast cancer were enrolled. ER and PR status by IHC were analyzed using the proportion of stained cells and staining intensity by Allred’s score. ResultsProportion score (PS) and intensity score (IS) were related to enzyme immunoassay (EIA) titers, for both in ER and PR(p < 0.0001, all). PS correlated with IS in both ER and PR (R=0.47 and 0.41,respectively). ER status by IHC was related to tumor size and lymph node status, while PR was related to tumor size and menopausal status. In 152 patients who received endocrine therapy with a median follow-up term of 38 months, differences in disease-free survival were most significant using a cut-off point of PS 3 which indicated more than 10% of cells stained positively for both ER and PR(p = 0.0007 and 0.0087, respectively). In addition, combination analysis of ER and PR using this cut-off point revealed a notable prognostic difference. ConclusionA 10% staining proportion may be an acceptable cut-off point for both ER and PR status by IHC, in terms of predicting response to endocrine therapy in breast cancer.
    Breast Cancer 01/2004; 11(3):267-275. · 1.33 Impact Factor
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    ABSTRACT: Effective long-term chemotherapy yielding good quality of life is essential. The clinical benefits of oral UFT and cyclophosphamide (CPA) combination chemotherapy for metastatic breast cancer (MBC) were evaluated. Twenty cases with MBC were enrolled. The mean age was 54 years. Five cases had loco-regional and others had distant metastasis. Nineteen cases had previous therapies. Daily treatment consisted of UFT (300 to 400 mg/body) and CPA (100 to 150 mg/body), both given orally. The treatment period ranged from 4 to 80 weeks. The response rate was 35%, while it was 65% in the "stable disease > 6 months" category. The mean time to the first sign of response was 7 weeks and the time to tumor progression was 37 weeks. The frequent adverse effects were leukocytopenia (55%) and gastrointestinal symptoms (35%). The incidence of adverse grade > or = 3 effects was 25%. Oral UFT and CPA combination chemotherapy may be suitable for MBC.
    Anticancer research 01/2003; 23(4):3453-7. · 1.71 Impact Factor
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    ABSTRACT: This study was conducted to assess the diagnostic potential and pitfalls of performing fine-needle aspiration cytology (FNAC) for thyroid nodules. We retrospectively analyzed 1012 aspirated samples obtained from 806 thyroid nodules by the ultrasound (US)-guided method. Of these 806 nodules, 226 (31%) had been surgically treated, 152 (67%) of which were histologically diagnosed as malignant. The rate of sufficient aspirate was 82%, being lower in nodules with a diameter of less than 5 mm (73%, P = 0.10); either calcified (77%, P = 0.043) or benign (72%, P = 0.0002). The accuracy of FNAC was 75%, the rate of indeterminate diagnosis was 16%, the false negative rate was 13%, and the positive malignancy rate was 99%. The rate of indeterminate diagnosis was higher in adenomatous goiter, follicular carcinoma, and malignant lymphoma, at P = 0.015, P = 0.0008, and P = 0.035, respectively. The accuracy was lower in follicular carcinoma and malignant lymphoma (both at P = 0.013). Sufficient aspirate was finally obtained from 701 (87%) of the 806 nodules by repeated aspiration. Of 152 malignant nodules, 28 (18%) were diagnosed after two or more aspirations, and the accuracy was improved to 81% by repeating the procedure. These findings indicated that repeated aspiration may be a simple and effective method of improving the diagnostic potential of FNAC.
    Surgery Today 01/2001; 31(2):97-101. · 0.96 Impact Factor
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    ABSTRACT: BACKGROUND The search for new tumor markers for breast carcinoma has been an area of vigorous study; nonetheless, to the authors' knowledge little new information has emerged beyond the clinical usefulness of CA 15-3. The authors studied serum CYFRA 21-1 in breast carcinoma based on evidence that breast carcinoma expresses cytokeratin 19 fragments and that CYFRA 21-1 is a specific antigen for cytokeratin 19 fragments.METHODS The serum samples of 86 patients with primary breast carcinoma, 14 patients with recurrent breast carcinoma, 22 patients with benign mammary disease, and 25 healthy controls were provided for measurements of CYFRA 21-1, carcinoembryonic antigen (CEA), and CA 15-3. The relation between clinicopathologic features, prognosis, and disease free survival with serum CYFRA 21-1 titers was studied.RESULTSThere was no difference between the serum CYFRA 21-1 titers from patients with benign mammary disease and those from healthy controls. The sensitivities of CYFRA 21-1 for patients with International Union Against Cancer Stage IV and recurrent tumors were 60% and 64.2%, respectively, which were as high as those for CA 15-3 and superior to those for CEA. The hematogenous recurrence showed a very high sensitivity of 89%. According to the increments of T, N, and M factor numbers, the serum CYFRA 21-1 titers were elevated. No correlation between CYFRA 21-1 and CEA was observed and the correlation between CYFRA 21-1 and CA 15-3 was weak. The univariate and multivariate analyses for survival revealed that serum CYFRA 21-1 levels were an independent indicator of prognosis.CONCLUSIONS The measurement of the serum CYFRA 21-1 titer in patients with breast carcinoma may be useful in monitoring for recurrence and evaluating the therapeutic effect in patients with advanced disease. Cancer 2000;89:1285–90. © 2000 American Cancer Society.
    Cancer 09/2000; 89(6):1285 - 1290. · 5.20 Impact Factor
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    ABSTRACT: Background. In breast cancer, the prognosis worsens with increasing lymph node involvement, and aggressive therapies may prolong survival in patients with advanced breast cancer. However, there are sub-populations of patients with advanced breast cancer with ten or more diseased nodes who have long survival. Implementing appropriate treatment depends on having a realistic and well-founded view of the prognosis. Methods. Sixty-nine patients (mean follow-up, 46 months) were enrolled. All patients underwent adjuvant therapy following radical mastectomy. Thirty-seven patients relapsed after curative surgery and 40 died of their cancer. Clinicopathologic factors, tumor estrogen receptor (ER) status, progesterone receptor status, and p53 protein expression were analyzed for prognostic significance. Results. Lower lymph node stage and positive ER status reflected longer relapse-free survival (P = 0.001 and P = 0.0001, respectively). Lower tumor stage (P = 0.039), lower lymph node stage (P = 0.006), absence of distant metastasis (P = 0.006), positive ER status (P = 0.0002), and negative p53 status (P = 0.02) reflected longer overall survival. ER status was the only independent significant prognostic factor for both relapse-free and overall survival. Conclusion. ER status, an indicator of response to endocrine therapy, was the most significant factor predicting prognosis in patients with breast cancer with ten or more positive lymph nodes.
    International Journal of Clinical Oncology 01/1999; 4(3):170-174. · 1.73 Impact Factor