This study supports the use of PET/CT in detecting osseous metastases for suspected MBC. Whether PET/CT may supplant BSc in this setting is unknown.

BACKGROUND: Pregnancy-associated breast cancer (PABC) may be defined as breast cancer diagnosed during pregnancy or within 1 year of giving birth. Conflicting data exist regarding the impact of pregnancy on clinical features and prognosis of breast cancer. METHODS: A single-institution retrospective chart review was performed of 99 patients identified with PABC between 1992 and 2007. Non-PABC controls were matched 2:1 to PABC cases by year of diagnosis and age. The differences in clinical features were compared between cases and controls using chi-square tests. Univariate and multivariate analyses were performed to assess the effect of PABC on survival. RESULTS: Of the 99 PABC cases, breast cancer was diagnosed during pregnancy in 36 patients, and after delivery in 63. PABC cases were more likely than controls to be negative for estrogen receptor (59% vs 31%, P < .0001) and negative for progesterone receptor (72% vs 40%, P < .0001). Cases were also more likely to have advanced T class (P ¼ .0271) and N class (P ¼ .0104) and higher grade tumors (P ¼ .0115). With a median follow-up of 6.3 years for cases and 4.7 years for controls, overall survival did not differ between cases and controls (P ¼ .0787). On multivariate analysis, the independent prognostic factors for overall survival were estrogen receptor status (P ¼ .0031) and N class (P ¼ .0003). The diagnosis of PABC was not an independent prognostic factor (P ¼ .1317). CONCLUSIONS: PABC is associated with more adverse tumor features than non-PABC matched for age and year of diagnosis. After correcting for pathologic features, the diagnosis of PABC is not in itself an adverse prognostic factor for survival. Cancer 2012;118:3254-9.

We have measured the firing rate and amplitude of 4551 motor unit action potentials (MUAPs) recorded with concentric needle electrodes from the brachial biceps muscles of 10 healthy young adults before, during, and after 45 minutes of intermittent isometric exercise at 20% of maximum voluntary contraction (MVC), using an automatic method for decomposition of electromyographic activity (ADEMG). During and after exercise, MUAPs derived from contractions of 30% MVC showed progressive increase in mean firing rate (P less than or equal to .01) and amplitude (P less than or equal to .05). The firing rate increase preceded the rise in mean amplitude, and was evident prior to the development of fatigue, defined as reduction of MVC. Analysis of individual potentials revealed that the increase in firing rate and in amplitude reflected different MUAP subpopulations. A short-term (less than 1 minute) reduction in MUAP firing rates (P less than or equal to .05) was also observed at the onset of each test contraction. These findings suggest that motor units exhibit a triphasic behavioral response to prolonged submaximal exercise: (1) short-term decline and stabilization of onset firing rates, followed by (2) gradual and progressive increase in firing rates and firing variability, and then by (3) recruitment of additional (larger) motor units. The (2) and (3) components presumably compensate for loss of force-generating capacity in the exercising muscle, and give rise jointly to the well-known increase in total surface EMG which accompanies muscle fatigue.

BACKGROUND: Several large, randomized trials established the benefits of adjuvant trastuzumab with chemotherapy. However, the benefit for women with small, node-negative HER2-positive (HER2þ) disease is unknown, as these patients were largely excluded from these trials. Therefore, a retrospective, single-institution, sequential cohort study of women with small, node-negative, HER2þ breast cancer who did or did not receive adjuvant trastuzumab was conducted. METHODS: Women with 2 cm, node-negative, HER2þ (immunohistochemistry 3þ or fluorescence in situ hybridization !2) breast cancer were identified through an institutional database. A ''no-trastuzumab'' cohort of 106 trastuzumab-untreated women diagnosed between January 1, 2002 and May 14, 2004 and a ''trastuzumab'' cohort of 155 trastuzumab-treated women diagnosed between May 16, 2005 and December 31, 2008 were described. Survival and recurrence outcomes were estimated by Kaplan-Meier methods. RESULTS: The cohorts were similar in age, median tumor size, histology, hormone receptor status, hormone therapy, and locoregional therapy. Chemotherapy was administered in 66% and 100% of the ''no trastuzumab'' and ''trastuzumab'' cohorts, respectively. The median recurrence-free and survival follow-up was: 6.5 years (0.7-8.5) and 6.8 years (0.7-8.5), respectively, for the ''no trastuzumab'' cohort and 3.0 years (0.5-5.2) and 3.0 years (0.6-5.2), respectively, for the ''trastuzumab'' cohort. The 3-year locoregional invasive recurrence-free, distant recurrence-free, invasive disease-free, and overall survival were 92% versus 98% (P ¼ .0137), 95% versus 100% (P ¼ .0072), 82% versus 97% (P < .0001), and 97% versus 99% (P ¼ .18) for the ''no trastuzumab'' and ''trastuzumab'' cohorts, respectively. CONCLUSIONS: Women with small, node-negative, HER2þ primary breast cancers likely derive significant benefit from adjuvant trastuzumab with chemotherapy. Cancer 2011;117:5461-

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DEBIRI is safe when appropriate technique and treatment are used. Adverse events can be predicted based on pretreatment- and treatment-related factors, and their occurrence can become part of the informed consent process. Continued standardization of this treatment will lead to fewer adverse events and improved patient quality of life.

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BACKGROUND:In this retrospective, single-institution study, the authors examine the maximum standardized uptake value (SUVmax) on positron emission tomography/computed tomography (PET/CT) images as a prognostic variable in patients with newly diagnosed metastatic breast cancer (MBC). METHODS: Patients with !1 metastatic lesion on PET/CT images that were obtained within 60 days of their MBC diagnosis between January 1, 2001 and December 31, 2008 were included. Patients were excluded if they had received chemotherapy 30 days before the PET/CT images were obtained. Electronic medical reports were reviewed to determine the SUVmax and overall survival. Because of intraindividual variation in the SUV by body site, separate analyses were conducted by metastatic site. Relationships between site-specific PET/CT variable tertiles and overall survival were assessed using Cox regression; hazard ratios for the highest tertile versus the lowest tertile were reported. RESULTS: In total, 253 patients were identified, and their median age was 57 years (range, 27-90 years). Of these, 152 patients (60%) died, and the median follow-up was 40 months. On univariate analysis, SUVmax tertile was strongly associated with overall survival in patients who had bone metastases (N ¼ 141; hazard ratio, 3.13; 95% confidence interval, 1.79-5.48; P < .001). This effect was maintained on multivariate analysis (HR ¼ 3.19; 95% confidence interval, 1.64-6.20, P ¼ .002) after correcting for known prognostic variables. A greater risk of death was associated with SUVmax tertile in patients who had metastases to the liver (N ¼ 46; hazard ratio, 2.07; 95% confidence interval, 0.90-4.76), lymph nodes (N ¼ 149; hazard ratio, 1.1; 95% confidence interval, 0.69-1.88), and lung (N ¼ 62; hazard ratio, 2.2; 95% confidence interval, 0.97-4.95), although these results were not significant (P ¼ .18, P ¼ .31, and P ¼ .095, respectively). CONCLUSIONS: The current results indicate that PET/CT has value as a prognostic tool in patients with newly diagnosed MBC to bone. Cancer 2012;118:5454-62. V C 2012 American Cancer Society.KEYWORDS: metastatic breast cancer, positron emission tomography/computed tomography, maximum standardized uptake value, prognosis, overall survival. INTRODUCTIONMetastatic breast cancer (MBC) represents a significant public health problem, because approximately 33% of the 1 million women who are diagnosed annually worldwide with early stage disease eventually will experience relapse, and a smaller number of patients present de novo with this disease. 1 After diagnosing MBC, clinicians and patients can use prognostic information to guide the selection of appropriate therapies to improve quality of life and maximize survival. Currently available prognostic tools focus on several clinicopathologic features, such as age and time from diagnosis of primary breast cancer, as well as tumor-related factors, like expression levels of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Although useful, t...