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Naoko Iwamoto

Bio: Naoko Iwamoto is an academic researcher from Tokyo Metropolitan Komagome Hospital. The author has contributed to research in topics: Breast cancer & Axillary lymph nodes. The author has an hindex of 2, co-authored 10 publications receiving 15 citations.

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Journal ArticleDOI
TL;DR: The objective of this study was to evaluate the accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes (LN) in breast cancer, to compare the results of FNAC and pathological examination, and to distinguish patients with 1 to 2 metastatic LNs from those with ≥3 metastasis LNs in patients with FNAC‐positive patients.
Abstract: Background The objective of this study was to evaluate the accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes (LN) in breast cancer, to compare the results of FNAC and pathological examination, and to distinguish patients with 1 to 2 metastatic LNs from those with ≥3 metastatic LNs in patients with FNAC-positive patients. Patients and methods This study included 198 breasts of 196 patients with breast cancer who underwent FNAC and surgery for the primary and axilla without neoadjuvant chemotherapy from January 2010 to August 2016. Axillary nodal status was assessed by ultrasound (US), and whether FNAC-positive had three or more suspicious LNs on US imaging was examined. Results The results of FNAC were positive in 75 (38%), negative in 97 (49%), suspicious in 2 (1%), indeterminate in 5 (2.5%), and insufficient in 19 patients (9.5%). FNAC sensitivity, specificity, positive predictive value, and negative predictive value were 62.6%, 100%, 100%, and 62.0%, respectively. Whereas 53% (18/34) of patients with false-negative FNAC had one metastatic LN on final pathology, 61% (47/77) patients who were FNAC-positive had three or more metastatic LNs. In the FNAC-positive patients, all patients had ≥3 metastatic LNs if they had ≥3 suspicious LNs on US imaging. Conclusion Patients with positive cytology were more likely to have ≥3 positive LNs compared to false-negative cytology patients. Patients with ≥3 abnormal LNs on US and positive FNAC might require axillary dissection.

10 citations

Journal ArticleDOI
TL;DR: The purpose of this study was to clarify the clinicopathological features of patients with false‐negative fine needle aspiration cytology (FNAC) and to determine the factors associated with negative FNAC.
Abstract: Introduction The purpose of this study was to clarify the clinicopathological features of patients with false-negative fine needle aspiration cytology (FNAC) and to determine the factors associated with negative FNAC Methods Patients with negative FNAC from January 2010 to December 2019 were included The patients with positive sentinel nodes (SN) were divided into two groups: micrometastasis (≤2 mm) group and macrometastasis (>2 mm) group The clinicopathological characteristics were compared between the two groups using the χ2 test Results A total of 165 patients with negative FNAC were included; 52 (315%) had positive SNs Of the 52 patients, 13 (25%) had micrometastasis and the remaining 39 (75%) had macrometastasis Of the 113 patients with negative SNs, none had metastases found in non-SNs No significant differences were observed in age, cT stage or subtype, and preoperative ultrasound findings between the two groups Conclusions The false-negative rate of FNAC was high (315%) Micrometastatic disease was seen in patients with negative FNAC, and this might be the cause of false-negative FNAC results

5 citations

Journal ArticleDOI
TL;DR: The upstaging rate in patients eligible for the clinical active surveillance trials was 12-25% as discussed by the authors, and the risk factors among patients with low-risk ductal carcinoma in situ were evaluated.
Abstract: Purpose Four clinical active surveillance trials including LORIS, COMET, LORD and LORETTA, are being conducted to assess whether women with low-risk ductal carcinoma in situ can safely avoid surgery. The present study aimed to determine the rate of upstaging to invasive cancer among patients with a preoperative diagnosis of ductal carcinoma in situ and to evaluate the incidence of upstaging in patients meeting the eligibility criteria for four active surveillance clinical trials. Methods The present study initially enrolled 180 patients with 183 calcifications who received the diagnosis of ductal carcinoma in situ by biopsy. Patients were classified as eligible for four clinical trials according to the respective inclusion criteria. Results In total, 152 patients with 155 calcifications were analyzed. Of these, 32 (21%) were upstaged to invasive disease based on the final pathological analysis of surgical specimens. Of the 152 patients, 53 (35%), 90 (59%), 24 (16%) and 34 (22%) met the eligibility criteria for the LORIS, COMET, LORD and LORETTA trial, respectively. Among patients with low-risk ductal carcinoma in situ, 10 (19%), 14 (16%), 6 (25%) and 4 (12%) patients were upstaged to invasive disease in LORIS, COMET, LORD and LORETTA, respectively. The upstaging to pT1b or higher rates were 2% (1/53), 3% (3/90), 0% (0/24) and 3% (1/34) in LORIS, COMET, LORD and LORETTA, respectively. Conclusions The upstaging rate in patients eligible for the clinical active surveillance trials was 12-25%. Although the rate of upstaging to pT1b or higher was low, further studies are required to determine the rates of upstaging to invasive cancer and the risk factors among patients with low-risk ductal carcinoma in situ.

4 citations

Proceedings ArticleDOI
TL;DR: Calretinin could distinguish between PT and FA and could therefore function as an important marker when planning surgery, and was found to be the specific marker for phyllodes tumor.
Abstract: Background Rare phyllodes tumors (PT) comprise a mixture of stromal and epithelial cells, and they can acquire malignant potential, which results in rapid progression and metastasis. Therefore, PT should be resected with an adequate free margin for curative intent. Fibroadenoma (FA) is a benign type of tumor that rarely becomes malignant, and usually does not require resection. However, PT and FA are morphologically and pathologically similar, which makes them difficult to distinguish in clinical practice. Thus, we aimed to determine a means of distinguishing them using a proteomic approach called Isobaric Tag for Relative and Absolute Quantitation (iTRAQ). We added different isobaric tags to normal and phyllodes tumor tissues, detected proteins using a database search and selected those that were at least three-fold more abundant than in normal tissue. Among them, we found high expression levels of calretinin, a specific marker for mesothelioma, in PT. Methods Tissue specimens were collected from 36 patients with PT (benign, n = 16; borderline, n = 15; malignant, n = 5), from 37 with FA and from three local recurrence sites of PT. All patients were treated by surgical resection at the Department of Breast Surgery, Tokyo Medical and Dental University, Japan, between March 2003 and August 2012. The specimens were analyzed by immunohistochemistry (IHC) using a calretinin antibody, and malignant mesothelioma as a positive control. Immunostaining for calretinin was analyzed by light microscopy in three high-power fields (HPF) and calretinin expression was assessed using Allred scores calculated on a scale from 0 to 8 as proportion (PS) plus intensity (IS) scores. We defined Allred scores of 0 and 2 as low (CLG) and those > 3 as high (CHG) calretin as reported for malignant mesothelioma. Data were analyzed using chi-square tests. Results All samples were stained. Stromal, but not epithelial cells tended to be positively stained for calretin. We found 20 and 17 FA, and 9 and 27 PT in CLG and CHG, respectively. More calretinin was expressed in PT than in FA (p = 0.011). Six and 25 benign or borderline PT were found in CLG and CHG, respectively. More calretinin was expressed in benign and borderline PT than in FA (p = 0.006). Three patients had local recurrence and one had distant metastasis. Recurrence did not significantly correlate with calretinin expression in PT; calretinin expression was low in all instances of local recurrence. Conclusion We found that calretinin could distinguish between PT and FA and could therefore function as an important marker when planning surgery. Malignant PT and sites of local recurrence tended to express low levels of calretinin. Further investigation of calretinin with PT and FA is needed. Citation Format: Tohiyuki Ishiba, Tomoyuki Aruga, Miyako Nara, Sakiko Yabe, Chiaki Saita, Mai Onishi, Naoko Iwamoto, Rika Yonekura, Hiromi Miyamoto, Yayoi Honda, Goshi Oda, Tsuyoshi Nakagawa, Akira Nakanishi, Hiroyuki Uetake, Yoshio Miki. Calretinin can be the specific marker for phyllodes tumor [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5449.

4 citations

Journal ArticleDOI
TL;DR: In this article, the short-term complications and long-term prognosis of immediate breast reconstruction after neoadjuvant chemotherapy (NAC) was assessed. But, the evaluation of the shortterm complications indicated no cases of total or partial flap necrosis, and one case of wound infection.
Abstract: Immediate breast reconstruction (IBR) is a standard option for breast cancer patients, although its utility in patients with advanced breast cancer requiring neoadjuvant chemotherapy (NAC) is debatable. We assessed the short-term complications and long-term prognosis of IBR after NAC. We retrospectively analyzed 1135 patients with IBR and/or NAC between 2010 and 2018, 43 of whom underwent IBR after NAC. Twenty-five patients underwent reconstruction with a tissue expander (TE) followed by silicon breast implantation, 5 with a latissimus dorsi muscle transfer flap, and 13 with a deep inferior epigastric perforator flap. Complete surgical resection with a free margin confirmed by a pathological assessment was achieved in all patients. The evaluation of the short-term complications indicated no cases of total flap necrosis, two cases of partial flap necrosis, and one case of wound infection. Only one case required postponement of subsequent therapy due to partial flap necrosis. A long-term evaluation indicated no local recurrence, although distant metastasis was observed in 4 cases, 3 patients died, and TE removal after post-mastectomy radiotherapy (PMRT) was performed in 2 of 11 TE cases. IBR may be a viable option in patients with advanced breast cancer who achieve complete surgical resection after NAC.

3 citations


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Journal ArticleDOI
28 Dec 2020
TL;DR: Palbociclib has been shown to improve progression-free survival in hormone receptor-positive (HR+), human epidermal growth factor receptor 2−negative (HER2−) patients.
Abstract: Background:Clinical studies have shown that palbociclib improves progression-free survival in hormone receptor–positive (HR+), human epidermal growth factor receptor 2–negative (HER2−) patients wit...

10 citations

Journal ArticleDOI
18 Sep 2020
TL;DR: Although the most sensitive test was found to be CNB in this study, there was no difference in specificity between various preoperative evaluations and the application of US-FNAC or CNB may be impacted by various factors.
Abstract: Background: The present study aims to evaluate the diagnostic accuracy between ultrasonography-guided fine-needle aspiration cytology (US-FNAC) and core needle biopsy (CNB) of axillary lymph nodes (ALNs) in patients with breast cancer through a meta-analysis and a diagnostic test accuracy (DTA) review. Methods: The present meta-analysis and DTA review included 67 eligible studies. The diagnostic accuracy of various preoperative assessments, including US-FNAC and CNB, was evaluated for ALNs assessments in patients with breast cancer. In addition, a subgroup analysis based on methods of cytologic preparation was performed. In the DTA review, the sensitivity, specificity, diagnostic odds ratio (OR) and area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated. Results: The diagnostic accuracy of the preoperative assessments of ALNs was 0.850 (95% confidence interval (CI) 0.833–0.866) for patients with breast cancer. The diagnostic accuracy of CNB was significantly higher than that of US-FNAC (0.896, 95% CI 0.844–0.932 vs. 0.844, 95% CI 0.825–0.862; p = 0.044 in a meta-regression test). In the subgroup analysis based on cytologic preparation, the diagnosis accuracies were 0.860, 0.861 and 0.859 for the methods of conventional smear, liquid-based preparation and cell block, respectively. In the DTA review, CNB showed higher sensitivity than US-FNAC (0.849 vs. 0.760). However, there was no difference in specificity between US-FNAC and CNB (0.997 vs. 1.000). US-FNAC with liquid-based preparation and CNB showed the highest diagnostic OR and AUC on the SROC, respectively. Conclusion: Both US-FNAC and CNB are useful in preoperative assessments of ALNs in patients with breast cancer. Although the most sensitive test was found to be CNB in this study, there was no difference in specificity between various preoperative evaluations and the application of US-FNAC or CNB may be impacted by various factors.

8 citations

Journal ArticleDOI
TL;DR: The purpose of this study was to clarify the clinicopathological features of patients with false‐negative fine needle aspiration cytology (FNAC) and to determine the factors associated with negative FNAC.
Abstract: Introduction The purpose of this study was to clarify the clinicopathological features of patients with false-negative fine needle aspiration cytology (FNAC) and to determine the factors associated with negative FNAC Methods Patients with negative FNAC from January 2010 to December 2019 were included The patients with positive sentinel nodes (SN) were divided into two groups: micrometastasis (≤2 mm) group and macrometastasis (>2 mm) group The clinicopathological characteristics were compared between the two groups using the χ2 test Results A total of 165 patients with negative FNAC were included; 52 (315%) had positive SNs Of the 52 patients, 13 (25%) had micrometastasis and the remaining 39 (75%) had macrometastasis Of the 113 patients with negative SNs, none had metastases found in non-SNs No significant differences were observed in age, cT stage or subtype, and preoperative ultrasound findings between the two groups Conclusions The false-negative rate of FNAC was high (315%) Micrometastatic disease was seen in patients with negative FNAC, and this might be the cause of false-negative FNAC results

5 citations

Journal ArticleDOI
TL;DR: The advancement of accurately locating sentinel lymph node (SLN) by isotope tracer imaging, magnetic tracer method, computed tomographic lymphography, and trans‐lymphatic contrast‐enhanced ultrasound is discussed, as well as proposing new propose for clinical diagnosis.
Abstract: Sentinel lymph node biopsy has been regarded as the standard procedure for early staging breast cancer. One of the key steps is to locate the sentinel lymph node (SLN). The recommended method is the joint use of blue dye and radioisotope. However, due to radionuclide radiation and high cost, it is urgent to develop more convenient and sensitive imaging methods to accurately locate SLN. This article discusses the advancement of accurately locating SLN by isotope tracer imaging, magnetic tracer method, computed tomographic lymphography, and trans‐lymphatic contrast‐enhanced ultrasound, as well as proposing new propose for clinical diagnosis.

4 citations

Journal ArticleDOI
TL;DR: In this paper, the diagnostic power of fine needle aspiration biopsy (FNAB) for differentiation between malignant and benign lesions on axillary masses and draw the physicians' attention to the benefits of FNAB cytology in the diagnosis of axillary mass was determined.
Abstract: Introduction We intend to determine the diagnostic power of fine needle aspiration biopsy (FNAB) for differentiation between malignant and benign lesions on axillary masses and draw the physicians' attention to the benefits of FNAB cytology in the diagnosis of axillary masses Methods In this study, 1,328 patients with an axillary mass diagnosed by FNAB were retrospectively reviewed These cases were registered at the affiliated hospital of Southwest Medical University (China), July 2014 to June 2017 Cytological results were verified either by histopathology following surgical resection or clinical follow-up Results Of the 1,328 patients affected by axillary masses, 987 (743%) cases were female, and 341 (257%) cases were male The highest incidence of patients was in the age group of 41-50 years (375, 282%) There were 1,129 (850%) patients with benign lesions and 199 (150%) with malignant lesions Of the 199 malignant lesions cases, 21 cases were lymphomas, 2 cases were accessory breast cancers, and 176 cases were lymph node metastatic tumors Under lymph node metastases, the most frequent primary tumors were breast cancer (141, 801%), followed by lung cancer (21, 119%) According to the study, the characters of 1,328 cases showed statistically significant difference (χ2 = 4534, p = 0033), and the incidence of females with axillary mass was significantly higher than that of males There was a statistically significant difference in the distribution of benign and malignant cases in the patient age groups (χ2 = 1129, p = 0000), and the incidence of patients of 41-50 years of age was significantly higher than that of other patients The diagnostic accuracy of FNAB in axillary masses was analyzed with the results of 9598% of sensitivity, 9956% of specificity, 9745% of positive predictive value, and 9929% of negative predictive value Conclusion Our results confirm that FNAB is a valuable initial screening method regarding pathologic diagnosis of axillary mass, in particular with respect to malignancy in 41- to 50-year-old female patients

4 citations