PET/CT May Improve Prognosis For Patients With Inflammatory Breast Cancer

In the largest study to date to evaluate fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) in the initial staging of inflammatory breast cancer (IBC), researchers were able to identify the precise location and extent of metastasis (spread of disease), offering the potential for a better prognosis for patients with this rare, but aggressive form of breast cancer.

"PET/CT is useful in staging IBC because it provides information on both the primary disease site as well as disease involvement throughout the rest of the body," said Homer A. Macapinlac, MD, chair and professor of nuclear medicine at the University of Texas, M. D. Anderson Cancer Center, Houston, Texas. "In addition to detecting the presence of cancer, PET/CT is able to demonstrate the biology of cancer—revealing how aggressive the disease is—which can help physicians develop appropriate therapy approaches."

For the study, published in the February issue of The Journal of Nuclear Medicine, researchers reported findings in 41 women between the ages of 25 and 71 with unilateral primary IBC who had originally presented with swelling, some pain and skin changes, such as rash and skin discoloration. A palpable mass was not evident on physical examination in 26 patients (63 percent), which is not unusual in this form of breast cancer, and 90 percent had no symptoms of distant metastasis (disease spread beyond the breast).

Each patient underwent a whole-body FDG-PET/CT exam. The scans showed that nearly half of the patients (49 percent) had distant metastasis, and 27 percent had disease in multiple sites. Neither finding had been previously detected by conventional imaging. These results were confirmed by biopsy and supplementary imaging.

"Breast cancer is a systemic disease, not just a local one. Most imaging modalities are localized and will therefore miss the spread of disease that is frequently present by the time IBC is diagnosed," Macapinlac said. "The use of a whole-body modality such as PET/CT with its higher sensitivity, however, allows us to pinpoint metastasis in other parts of the body; for example, behind the clavicle—which can not be detected in a physical exam—or in the abdominal organs or pelvic lymph nodes."

IBC tends to grow more quickly and aggressively than the more common types of breast cancer. Upon diagnosis, it is already considered to be at least stage IIIB (locally advanced) and even stage IV if it has spread to distant parts of the body. Because of this, IBC has been harder to successfully treat than other types of breast cancer. Knowing the extent of the disease at the start could have a great impact on the outcome for many patients, Macapinlac added.

"With FDG-PET/CT, physicians are able to accurately determine the location of metastases early in the disease process when appropriate treatment can be administered. Furthermore, a PET/CT procedure for IBC patients may be less than or equivalent to the total cost of separately imaging multiple organs and would require a single hospital visit and decreased imaging time when compared to the time required for a battery of regional staging studies," Macapinlac said.

The researchers would like to see future studies that use PET/CT earlier in the process and also to track therapy response to determine whether or not it is succeeding.

"Knowing the extent of disease up front has great implication for prognosis," Macapinlac said. "IBC is a treatable disease. The sooner we can determine the extent, the sooner we can begin aggressive therapy."

PET provides information about how the body is functioning at the cellular level, while CT provides an anatomical rendering of the inside of the body. In an FDG-PET/CT scan, the CT first produces detailed images of the inner anatomy of the body. The patient is then injected with a small amount of a radioactive drug, which is F-18-labeled glucose, and PET is performed. Because fast-growing cancer cells feed on sugars such as glucose, PET/CT delineates areas where the glucose accumulates in the body, identifying the location of cancer cells.

According to the American Cancer Society, IBC accounts for approximately 1 to 3 percent of all breast cancers diagnosed in the United States. It tends to occur in younger women, and African-Americans appear to be at higher risk. Physicians call the disease "inflammatory breast cancer" because the affected breast displays the same symptoms that occur with inflammation. However, the symptoms of IBC are not caused by infection or injury, but by cancer cells blocking lymph vessels in the skin. Patients often do not have a breast lump, and symptoms may not show up on a mammogram. Because it doesn't look like a typical breast cancer, the disease can be harder to diagnose.

New Technique Developed For Quick Detection Of Salmonella

In the hours following an outbreak of salmonella, there are many questions. And answers can be hard to find. Where did the problem start? Can it be contained? Is the sickness likely to spread?

Iowa State University researchers have developed a technique for testing for the presence of salmonella that may give investigators better, faster answers.

The process, developed by Byron Brehm-Stecher, assistant professor in food science and human nutrition, and his graduate student Bledar Bisha, begins with testing the food, in most cases produce, with a strip of adhesive tape.

The tape is applied to the produce, then carefully removed, taking a sample of whatever is on the skin of the produce. That sample is then put on a slide and soaked in a special warm, soapy mixture that contains a genetic marker that binds with salmonella and gives off a fluorescent glow when viewed under an ultraviolet light. Use of this genetic marker approach is called Fluorescent In-Situ Hybridization, or FISH.

The approach can tell investigators if the produce is contaminated with salmonella in about two hours.

"This method is rapid, it's easy, and it's cheap," said Brehm-Stecher.

Current methods of detecting salmonella take one to seven days.

Brehm-Stecher and Bisha call the process "tape-FISH" and note that it could be an important technique for salmonella investigators.

"I think this will be good tool in outbreak investigation and routine surveillance especially since all you need is tape, a heat block, a small centrifuge and a fluorescence microscope," said Brehm-Stecher. "It has the potential to be very portable."

Brehm-Stecher's and Bisha's findings will be published in the journal Applied and Environmental Microbiology, published by the American Society of Microbiology.

Once at a location where an outbreak of salmonella has occurred, investigators can test the produce for contamination. Outbreaks can be due to other factors such as food preparation.

Once investigators find the origin of the salmonella, they can take steps to contain it, said Brehm-Stecher.

Salmonella can be found on produce such as tomatoes, cilantro, peppers, spinach and others. The produce can be contaminated while it is in the fields or during processing. Washing the produce thoroughly can help, but cannot ensure the produce will be safe.

The tape-FISH technique can also be used to test produce that is not suspected of being contaminated, but the volume of produce that would need to be tested may make this impractical. However, the technique could be very valuable as a basic research tool. Researchers could investigate how salmonella and other types of organisms interact on produce surfaces, said Brehm-Stecher.

This is the first application of tape-FISH to salmonella, but the idea came to the ISU researcher while reading about art restoration.

In 2008, Brehm-Stecher read about an Italian group that was using a similar approach to look for bacteria on ancient catacombs. Those researchers were hoping to identify and remove bacteria that were slowly eating away at the relics.

After some classroom discussion with his students, Brehm-Stecher decided that using the FISH on produce could be useful and began researching the idea with Bisha. Together, they were able to apply the method to produce and made several improvements in speed and sensitivity over the existing tape-FISH approach. Brehm-Stecher hopes that his tape-FISH approach can help speed investigations of produce contamination, such as last summer's outbreak of Salmonella Saintpaul, which was eventually traced to imported jalapeno and Serrano peppers.

Don’t Go Changing: New Chemical Keeps Stem Cells Young

Scientists at the Universities of Bath and Leeds have discovered a chemical that stops stem cells from turning into other cell types, allowing researchers to use these cells to develop new medical treatments more easily.

Stem cells have the ability to develop into many other cell types in the body, and scientists believe they have huge potential to treat diseases or injuries that don’t currently have a cure.

Professor Melanie Welham’s team at the University of Bath’s Department of Pharmacy & Pharmacology, collaborating with Professor Adam Nelson at the University of Leeds, have discovered a chemical that can be added to embryonic stem cells grown in the lab, allowing them to multiply without changing into other cell types.

This breakthrough will help scientists produce large stocks of cells that are needed for developing new medical therapies.

Professor Welham, who is co-director of the University of Bath’s Centre for Regenerative Medicine, explained: “Stem cells have great potential for treating spinal injuries and diseases like type I diabetes because they can change into a range of specialised cell types including nerve or pancreatic cells, which could be used to repair damaged tissues.

“Unfortunately, when you grow stem cells in the lab, they can spontaneously develop into specialised cells, making it difficult to grow large enough stocks to use for medical research.

“We’ve identified a chemical that will put this process on hold for several weeks so that we can grow large numbers of them in their unspecialised state. This is reversible, so when you take it away from the cells, they still have the ability to change into specialised cells.”

Professor Adam Nelson’s team, at the Astbury Centre for Structural Molecular Biology, made more than 50 chemical compounds that were tested for activity in the stem cells.The researchers found that the chemicals worked by blocking an enzyme, called GSK3, that can control when the stem cell switches to a more specialised cell type.

Professor Nelson, who is Director of the Astbury Centre at the University of Leeds, said: “This research is a great example of how small molecules can be used as tools to understand biological mechanisms.”

The research, supported by funding from the Biotechnology & Biological Sciences Research Council.