Jane Fox | Monash University (original) (raw)

Papers by Jane Fox

Research paper thumbnail of Effect of x-ray energy on the radiological image quality in propagation-based phase-contrast computed tomography of the breast

Journal of Medical Imaging, 2021

Abstract. Purpose: Breast cancer is the most common cancer in women in developing and developed c... more Abstract. Purpose: Breast cancer is the most common cancer in women in developing and developed countries and is responsible for 15% of women’s cancer deaths worldwide. Conventional absorption-based breast imaging techniques lack sufficient contrast for comprehensive diagnosis. Propagation-based phase-contrast computed tomography (PB-CT) is a developing technique that exploits a more contrast-sensitive property of x-rays: x-ray refraction. X-ray absorption, refraction, and contrast-to-noise in the corresponding images depend on the x-ray energy used, for the same/fixed radiation dose. The aim of this paper is to explore the relationship between x-ray energy and radiological image quality in PB-CT imaging. Approach: Thirty-nine mastectomy samples were scanned at the imaging and medical beamline at the Australian Synchrotron. Samples were scanned at various x-ray energies of 26, 28, 30, 32, 34, and 60 keV using a Hamamatsu Flat Panel detector at the same object-to-detector distance of...

Research paper thumbnail of Changes in aldehyde dehydrogenase-1 expression during neoadjuvant chemotherapy predict outcome in locally advanced breast cancer

Breast Cancer Research, 2014

Introduction: Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can impr... more Introduction: Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can improve operability and local disease control, there is a lack of reliable biomarkers that predict response to chemotherapy or long-term survival. Since expression of aldehyde dehydrogenase-1 (ALDH1) is associated with the stem-like properties of self-renewal and innate chemoresistance in breast cancer, we asked whether expression in serial tumor samples treated with NAC could identify women more likely to benefit from this therapy. Methods: Women with locally advanced breast cancer were randomly assigned to receive four cycles of anthracycline-based chemotherapy, followed by four cycles of taxane therapy (Arm A), or the same regimen in reverse order (Arm B). Tumor specimens were collected at baseline, after four cycles, and then at surgical resection. ALDH1 expression was determined by immunohistochemistry and correlated with tumor response using Fisher's exact test while Kaplan-Meier method was used to calculate survival. Results: A hundred and nineteen women were enrolled into the study. Fifty seven (48%) were randomized to Arm A and 62 (52%) to Arm B. Most of the women (90%) had ductal carcinoma and 10% had lobular carcinoma. Of these, 26 (22%) achieved a pathological complete response (pCR) after NAC. There was no correlation between baseline ALDH1 expression and tumor grade, stage, hormone receptor, human epidermal growth factor receptor 2 (HER2) status and Ki67 index. ALDH1 negativity at baseline was significantly associated with pCR (P = 0.004). The presence of ALDH1(+) cells in the residual tumor cells in non-responding women was strongly predictive of worse overall survival (P = 0.024). Moreover, serial analysis of specimens from non-responders showed a marked increase in tumor-specific ALDH1 expression (P = 0.028). Overall, there was no survival difference according to the chemotherapy sequence. However, poorly responding tumours from women receiving docetaxel chemotherapy showed an unexpected significant increase in ALDH1 expression. Conclusions: ALDH1 expression is a useful predictor of chemoresistance. The up-regulation of ALDH1 after NAC predicts poor survival in locally advanced breast cancer. Although the chemotherapy sequence had no effect on overall prognosis, our results suggest that anthracycline-based chemotherapy may be more effective at targeting ALDH1(+) breast cancer cells.

Research paper thumbnail of The role of chemotherapeutic drugs in the evaluation of breast tumour response to chemotherapy using serial FDG-PET

Breast Cancer Research, 2010

Introduction: The aims of this study were to investigate whether drug sequence (docetaxel followe... more Introduction: The aims of this study were to investigate whether drug sequence (docetaxel followed by anthracyclines or the drugs in reverse order) affects changes in the maximal standard uptake volume (SUV max) on [ 18 F]flourodeoxyglucose positron emission tomography (FDG-PET) during neoadjuvant chemotherapy in women with locally advanced breast cancer. Methods: Women were randomly assigned to receive either drug sequence, and FDG-PET scans were taken at baseline, after four cycles and after eight cycles of chemotherapy. Tumour response to chemotherapy was evaluated based on histology from a surgical specimen collected upon completion of chemotherapy. Results: Sixty women were enrolled into the study. Thirty-one received docetaxel followed by anthracyclines (Arm A) and 29 received drugs in the reverse order (Arm B). Most women (83%) had ductal carcinoma and 10 women (17%) had lobular or lobular/ductal carcinoma. All but one tumour were downstaged during therapy. Overall, there was no significant difference in response between the two drug regimens. However, women in Arm B who achieved complete pathological response had mean FDG-PET SUV max reduction of 87.7% after four cycles, in contrast to those who had no or minor pathological response. These women recorded mean SUV max reductions of only 27% (P < 0.01). Women in Arm A showed no significant difference in SUV max response according to pathological response. Sensitivity, specificity, accuracy and positive and negative predictive values were highest in women in Arm B. Conclusions: Our results show that SUV max uptake by breast tumours during chemotherapy can be dependent on the drugs used. Care must be taken when interpreting FDG-PET in settings where patients receive varied drug protocols.

Research paper thumbnail of Tumor inherent interferon regulators as biomarkers of long-term chemotherapeutic response in TNBC

npj Precision Oncology, 2019

Patients diagnosed with triple negative breast cancer (TNBC) have an increased risk of rapid meta... more Patients diagnosed with triple negative breast cancer (TNBC) have an increased risk of rapid metastasis compared to other subtypes. Predicting long-term survival post-chemotherapy in patients with TNBC is difficult, yet enhanced infiltration of tumor infiltrating lymphocytes (TILs) has been associated with therapeutic response and reduced risk of metastatic relapse. Immune biomarkers that predict the immune state of a tumor and risk of metastatic relapse pre-or mid-neoadjuvant chemotherapy are urgently needed to allow earlier implementation of alternate therapies that may reduce TNBC patient mortality. Utilizing a neoadjuvant chemotherapy trial where TNBC patients had sequential biopsies taken, we demonstrate that measurement of T-cell subsets and effector function, specifically CD45RO expression, throughout chemotherapy predicts risk of metastatic relapse. Furthermore, we identified the tumor inherent interferon regulatory factor IRF9 as a marker of active intratumoral type I and II interferon (IFN) signaling and reduced risk of distant relapse. Functional implications of tumor intrinsic IFN signaling were demonstrated using an immunocompetent mouse model of TNBC, where enhanced type I IFN signaling increased anti-tumor immunity and metastasis-free survival post-chemotherapy. Using two independent adjuvant cohorts we were able to validate loss of IRF9 as a poor prognostic biomarker pre-chemotherapy. Thus, IRF9 expression may offer early insight into TNBC patient prognosis and tumor heat, allowing for identification of patients that are unlikely to respond to chemotherapy alone and could benefit from further immune-based therapeutic intervention.

Research paper thumbnail of Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study

Research paper thumbnail of Propagation-Based Phase-Contrast CT of the Breast Demonstrates Higher Quality Than Conventional Absorption-Based CT Even at Lower Radiation Dose

Research paper thumbnail of High-Resolution X-ray Phase-Contrast 3D Imaging of Breast Tissue Specimens as a Possible Adjunct to Histopathology

IEEE transactions on medical imaging, Jan 11, 2018

THistopathological analysis is the current gold standard in breast cancer diagnosis and managemen... more THistopathological analysis is the current gold standard in breast cancer diagnosis and management, however, as imaging technology improves, the amount of potential diagnostic information that may be demonstrable radiologically should also increase. We aimed to evaluate the potential clinical usefulness of 3D phase-contrast micro-computed tomography (micro-CT) imaging at high spatial resolutions as an adjunct to conventional histological microscopy. Ten breast tissue specimens, 2 mm in diameter, were scanned at the SYRMEP beamline of the Elettra Synchrotron using the propagation-based phase-contrast micro-tomography method. We obtained 1.2 ìm pixel size images, which were analysed and compared with corresponding histological sections examined under light microscopy. To evaluate the effect of spatial resolution on breast cancer diagnosis, scans with 4 different pixel sizes were also performed. Our comparative analysis revealed that high-resolution images can enable, at a near-histolo...

Research paper thumbnail of Advantages of breast cancer visualization and characterization using synchrotron radiation phase-contrast tomography

Journal of synchrotron radiation, 2018

The aim of this study was to highlight the advantages that propagation-based phase-contrast compu... more The aim of this study was to highlight the advantages that propagation-based phase-contrast computed tomography (PB-CT) with synchrotron radiation can provide in breast cancer diagnostics. For the first time, a fresh and intact mastectomy sample from a 60 year old patient was scanned on the IMBL beamline at the Australian Synchrotron in PB-CT mode and reconstructed. The clinical picture was described and characterized by an experienced breast radiologist, who underlined the advantages of providing diagnosis on a PB-CT volume rather than conventional two-dimensional modalities. Subsequently, the image quality was assessed by 11 breast radiologists and medical imaging experts using a radiological scoring system. The results indicate that, with the radiation dose delivered to the sample being equal, the accuracy of a diagnosis made on PB-CT images is significantly higher than one using conventional techniques.

Research paper thumbnail of Immunoglobulin-G4 related mastitis: A case report

International journal of surgery case reports, 2017

IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literatur... more IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literature to date. Organs that are affected with IgG4-related disease (IgG4-RD) all share the same histopathological hallmarks consisting of dense lymphocytic infiltration, storiform fibrosis and obliterative phlebitis. This case report highlights a case of IgG4-RM found incidentally in a 52-year-old woman during a routine breast screen and it explores the current literature about IgG4-RM and IgG4-RD. IgG4-RM and IgG4-RD, in general, is a new entity in the field of medicine and its aetiology is not well understood. In the literature, IgG4-RM often presents as a painless palpable breast lump in isolation or with other systemic manifestations. IgG4-RM is considered benign and has excellent prognosis post-conservative treatment with steroid or surgical excision. IgG4-RM is diagnosed exclusively on histological analysis. It is hard to distinguish IgG4-RD from malignant breast lesions purely on clini...

Research paper thumbnail of Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin

Australian and New Zealand Journal of Surgery, Mar 1, 2002

Background: Unlike other cancers, breast cancer does not occur at increased frequency in renal tr... more Background: Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied. Methods: The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year. Results: In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25-70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25-18.5 years). Eighty-seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had 'dense mammograms', all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study. Conclusion: The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.

Research paper thumbnail of Mapping structural changes in breast tissue disease using x-ray scattering

Spread of invasive carcinoma throughout breast tissue is believed to occur at supramolecular leve... more Spread of invasive carcinoma throughout breast tissue is believed to occur at supramolecular levels, beyond the range of standard histopathology identification. Small angle x-ray scattering (SAXS) is capable of characterizing the structural properties of collagen and tissue found in the breast at the scale of tens to hundreds of nanometers. Fifty-six patients who were treated with wide-local excision or mastectomy had tissue biopsy samples analyzed at 2 cm intervals along two perpendicular axes over their excised mass, up to 6 cm away from the primary site of the tumor. Two SAXS parameters, the integrated amorphous scatter and the third order collagen axial d spacing, showed significant differences between the center (0 cm) and distant tissues (2, 4, or 6 cm from the primary lesion). There was no evidence of directional trends (superior, inferior, or lateral sides of the nipple) of these two parameters over the breast. Mapping of these two variables over a two-dimensional grid showed good matching with independent histopathology diagnosis. These results suggest that SAXS may be capable of identifying areas of invasion or directional spread of disease as well as providing more information at the supramolecular level for aiding tissue diagnosis.

Research paper thumbnail of Breast problems

Hunt & Marshall's Clinical Problems in Surgery, 2010

Research paper thumbnail of Integument problems

Hunt & Marshall's Clinical Problems in Surgery, 2010

Research paper thumbnail of Resurveying micrometastases in breast cancer: have we now turned the corner?

ANZ Journal of Surgery, 2014

Research paper thumbnail of Sentinel node micrometastases in breast cancer: a survey of Australian and New Zealand breast surgeons

ANZ Journal of Surgery, 2012

Research paper thumbnail of Changes in ALDEHYDE DEHYDROGENASE-1 expression during neoadjuvant chemotherapy predict outcome in locally advanced breast cancer

Breast Cancer Research, 2014

Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can improve operabilit... more Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can improve operability and local disease control, there is a lack of reliable biomarkers that predict response to chemotherapy or long-term survival. Since expression of aldehyde dehydrogenase-1 (ALDH1) is associated with the stem-like properties of self-renewal and innate chemoresistance in breast cancer, we asked whether expression in serial tumor samples treated with NAC could identify women more likely to benefit from this therapy. Women with locally advanced breast cancer were randomly assigned to receive four cycles of anthracycline-based chemotherapy, followed by four cycles of taxane therapy (Arm A), or the same regimen in reverse order (Arm B). Tumor specimens were collected at baseline, after four cycles, and then at surgical resection. ALDH1 expression was determined by immunohistochemistry and correlated with tumor response using Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test while Kaplan-Meier method was used to calculate survival. A hundred and nineteen women were enrolled into the study. Fifty seven (48%) were randomized to Arm A and 62 (52%) to Arm B. Most of the women (90%) had ductal carcinoma and 10% had lobular carcinoma. Of these, 26 (22%) achieved a pathological complete response (pCR) after NAC. There was no correlation between baseline ALDH1 expression and tumor grade, stage, hormone receptor, human epidermal growth factor receptor 2 (HER2) status and Ki67 index. ALDH1 negativity at baseline was significantly associated with pCR (P = 0.004). The presence of ALDH1(+) cells in the residual tumor cells in non-responding women was strongly predictive of worse overall survival (P = 0.024). Moreover, serial analysis of specimens from non-responders showed a marked increase in tumor-specific ALDH1 expression (P = 0.028). Overall, there was no survival difference according to the chemotherapy sequence. However, poorly responding tumours from women receiving docetaxel chemotherapy showed an unexpected significant increase in ALDH1 expression. ALDH1 expression is a useful predictor of chemoresistance. The up-regulation of ALDH1 after NAC predicts poor survival in locally advanced breast cancer. Although the chemotherapy sequence had no effect on overall prognosis, our results suggest that anthracycline-based chemotherapy may be more effective at targeting ALDH1(+) breast cancer cells. ACTRN12605000588695.

Research paper thumbnail of Small Angle X-Ray Scattering Signatures for Breast Cancer Detection: Direct Comparison of Synchrotron and Laboratory X-Ray Sources

IFMBE Proceedings, 2009

ABSTRACT Scattering signatures from human breast tissue acquired on a synchrotron x-ray source an... more ABSTRACT Scattering signatures from human breast tissue acquired on a synchrotron x-ray source and a laboratory instrument have been directly compared. We have previously established that the amorphous scatter intensity is extremely sensitive to disease status, able to detect the molecular changes in healthy tissue from patients with verified disease before the conventional histological markers of cancer are visible. SAXS images of tissue samples from 130 patients were imaged on a synchrotron source, and matched samples from 66 of these patients were also imaged on a laboratory source. The results indicate that not only does the integrated amorphous scattering intensity increase with disease severity for both sources, but that the size of the predominant scatterers also appears to decrease with disease progression. KeywordsBreast cancer-extra-cellular matrix-x-ray scattering

Research paper thumbnail of Classification of breast tissue using a laboratory system for small-angle x-ray scattering (SAXS)

Physics in Medicine and Biology, 2011

Structural changes in breast tissue at the nanometre scale have been shown to differentiate betwe... more Structural changes in breast tissue at the nanometre scale have been shown to differentiate between tissue types using synchrotron SAXS techniques. Classification of breast tissues using information acquired from a laboratory SAXS camera source could possibly provide a means of adopting SAXS as a viable diagnostic procedure. Tissue samples were obtained from surgical waste from 66 patients and structural components of the tissues were examined between q = 0.25 and 2.3 nm(-1). Principal component analysis showed that the amplitude of the fifth-order axial Bragg peak, the magnitude of the integrated intensity and the full-width at half-maximum of the fat peak were significantly different between tissue types. A discriminant analysis showed that excellent classification can be achieved; however, only 30% of the tissue samples provided the 16 variables required for classification. This suggests that the presence of disease is represented by a combination of factors, rather than one specific trait. A closer examination of the amorphous scattering intensity showed not only a trend of increased scattering intensity with disease severity, but also a corresponding decrease in the size of the scatterers contributing to this intensity.

Research paper thumbnail of X-ray scattering for classifying tissue types associated with breast disease

Medical Physics, 2008

Collagen types I and III can be characterized at the molecular level (at the tens to hundreds of ... more Collagen types I and III can be characterized at the molecular level (at the tens to hundreds of nanometers scale) using small angle x-ray scattering (SAXS). Although collagen fibril structural parameters at this length scale have shown differences between diseased and nondiseased breast tissues, a comprehensive analysis involving a multitude of features with a large (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50) patient cohort has not previously been investigated. Breast tissue samples were excised from 80 patients presenting with either a breast lump or reduction mammoplasty. From these, invasive carcinoma, benign tissue, and normal parenchyma were analyzed. Parameters related to collagen structure, including longitudinal (axial) and lateral (equatorial) features, polar angle features, total scattering intensity, and tissue heterogeneity effects, were extracted from the SAXS patterns and examined. The amplitude of the third-order axial peak and the total scattering intensity (amorphous scatter) showed the most separation between tissue groups and a classification model using these two parameters demonstrated an accuracy of over 95% between invasive carcinoma and mammoplasty patients. Normal tissue taken from disease-free patients (mammoplasty) and normal tissue taken from patients with presence of disease showed significant differences, suggesting that SAXS may provide different diagnostic information from that of conventional histopathology.

Research paper thumbnail of Fourier transform infrared imaging and small angle x-ray scattering as a combined biomolecular approach to diagnosis of breast cancer

Medical Physics, 2008

Fourier transform infrared (FTIR) microspectroscopic imaging and small angle x-ray scattering (SA... more Fourier transform infrared (FTIR) microspectroscopic imaging and small angle x-ray scattering (SAXS) were combined to investigate the supramolecular structure of collagen from 27 tissue sections from patients undergoing mastectomy, excisional biopsy, or mammoplasty. Both techniques were correlated by matching the scattering profile from the SAXS data with the integrated area of the infrared collagen region (1300-1180 cm(-1)). The FTIR spectral profiles and multivariate analysis of various tissue components showed consistent differences between all major tissue components, particularly between cancer and normal tissue cells. Analysis of the SAXS data revealed broad differences between cancer and normal tissue, but were inconclusive due to the small sample size. Parameters were extracted from each technique in relation to their characterization of collagen to reveal a good correlation between the two techniques, which diagnostically parallels with gold-standard Hematoxylin and Eosin (H&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;E) stained sections. The results show that the integrated area of collagen region in the FTIR spectrum for cancerous samples is greater than that for noncancerous samples indicating collagen disorder. This supports the notion that collagen is structurally disrupted in cancer tissue consistent with the interpretation of the SAXS data. Overall, both these techniques successfully distinguished cancer from normal breast tissue. Integration of these two techniques was able to better segregate cancer as well as provide a more complete understanding of the differences in collagen on all structural levels during breast cancer development.

Research paper thumbnail of Effect of x-ray energy on the radiological image quality in propagation-based phase-contrast computed tomography of the breast

Journal of Medical Imaging, 2021

Abstract. Purpose: Breast cancer is the most common cancer in women in developing and developed c... more Abstract. Purpose: Breast cancer is the most common cancer in women in developing and developed countries and is responsible for 15% of women’s cancer deaths worldwide. Conventional absorption-based breast imaging techniques lack sufficient contrast for comprehensive diagnosis. Propagation-based phase-contrast computed tomography (PB-CT) is a developing technique that exploits a more contrast-sensitive property of x-rays: x-ray refraction. X-ray absorption, refraction, and contrast-to-noise in the corresponding images depend on the x-ray energy used, for the same/fixed radiation dose. The aim of this paper is to explore the relationship between x-ray energy and radiological image quality in PB-CT imaging. Approach: Thirty-nine mastectomy samples were scanned at the imaging and medical beamline at the Australian Synchrotron. Samples were scanned at various x-ray energies of 26, 28, 30, 32, 34, and 60 keV using a Hamamatsu Flat Panel detector at the same object-to-detector distance of...

Research paper thumbnail of Changes in aldehyde dehydrogenase-1 expression during neoadjuvant chemotherapy predict outcome in locally advanced breast cancer

Breast Cancer Research, 2014

Introduction: Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can impr... more Introduction: Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can improve operability and local disease control, there is a lack of reliable biomarkers that predict response to chemotherapy or long-term survival. Since expression of aldehyde dehydrogenase-1 (ALDH1) is associated with the stem-like properties of self-renewal and innate chemoresistance in breast cancer, we asked whether expression in serial tumor samples treated with NAC could identify women more likely to benefit from this therapy. Methods: Women with locally advanced breast cancer were randomly assigned to receive four cycles of anthracycline-based chemotherapy, followed by four cycles of taxane therapy (Arm A), or the same regimen in reverse order (Arm B). Tumor specimens were collected at baseline, after four cycles, and then at surgical resection. ALDH1 expression was determined by immunohistochemistry and correlated with tumor response using Fisher's exact test while Kaplan-Meier method was used to calculate survival. Results: A hundred and nineteen women were enrolled into the study. Fifty seven (48%) were randomized to Arm A and 62 (52%) to Arm B. Most of the women (90%) had ductal carcinoma and 10% had lobular carcinoma. Of these, 26 (22%) achieved a pathological complete response (pCR) after NAC. There was no correlation between baseline ALDH1 expression and tumor grade, stage, hormone receptor, human epidermal growth factor receptor 2 (HER2) status and Ki67 index. ALDH1 negativity at baseline was significantly associated with pCR (P = 0.004). The presence of ALDH1(+) cells in the residual tumor cells in non-responding women was strongly predictive of worse overall survival (P = 0.024). Moreover, serial analysis of specimens from non-responders showed a marked increase in tumor-specific ALDH1 expression (P = 0.028). Overall, there was no survival difference according to the chemotherapy sequence. However, poorly responding tumours from women receiving docetaxel chemotherapy showed an unexpected significant increase in ALDH1 expression. Conclusions: ALDH1 expression is a useful predictor of chemoresistance. The up-regulation of ALDH1 after NAC predicts poor survival in locally advanced breast cancer. Although the chemotherapy sequence had no effect on overall prognosis, our results suggest that anthracycline-based chemotherapy may be more effective at targeting ALDH1(+) breast cancer cells.

Research paper thumbnail of The role of chemotherapeutic drugs in the evaluation of breast tumour response to chemotherapy using serial FDG-PET

Breast Cancer Research, 2010

Introduction: The aims of this study were to investigate whether drug sequence (docetaxel followe... more Introduction: The aims of this study were to investigate whether drug sequence (docetaxel followed by anthracyclines or the drugs in reverse order) affects changes in the maximal standard uptake volume (SUV max) on [ 18 F]flourodeoxyglucose positron emission tomography (FDG-PET) during neoadjuvant chemotherapy in women with locally advanced breast cancer. Methods: Women were randomly assigned to receive either drug sequence, and FDG-PET scans were taken at baseline, after four cycles and after eight cycles of chemotherapy. Tumour response to chemotherapy was evaluated based on histology from a surgical specimen collected upon completion of chemotherapy. Results: Sixty women were enrolled into the study. Thirty-one received docetaxel followed by anthracyclines (Arm A) and 29 received drugs in the reverse order (Arm B). Most women (83%) had ductal carcinoma and 10 women (17%) had lobular or lobular/ductal carcinoma. All but one tumour were downstaged during therapy. Overall, there was no significant difference in response between the two drug regimens. However, women in Arm B who achieved complete pathological response had mean FDG-PET SUV max reduction of 87.7% after four cycles, in contrast to those who had no or minor pathological response. These women recorded mean SUV max reductions of only 27% (P < 0.01). Women in Arm A showed no significant difference in SUV max response according to pathological response. Sensitivity, specificity, accuracy and positive and negative predictive values were highest in women in Arm B. Conclusions: Our results show that SUV max uptake by breast tumours during chemotherapy can be dependent on the drugs used. Care must be taken when interpreting FDG-PET in settings where patients receive varied drug protocols.

Research paper thumbnail of Tumor inherent interferon regulators as biomarkers of long-term chemotherapeutic response in TNBC

npj Precision Oncology, 2019

Patients diagnosed with triple negative breast cancer (TNBC) have an increased risk of rapid meta... more Patients diagnosed with triple negative breast cancer (TNBC) have an increased risk of rapid metastasis compared to other subtypes. Predicting long-term survival post-chemotherapy in patients with TNBC is difficult, yet enhanced infiltration of tumor infiltrating lymphocytes (TILs) has been associated with therapeutic response and reduced risk of metastatic relapse. Immune biomarkers that predict the immune state of a tumor and risk of metastatic relapse pre-or mid-neoadjuvant chemotherapy are urgently needed to allow earlier implementation of alternate therapies that may reduce TNBC patient mortality. Utilizing a neoadjuvant chemotherapy trial where TNBC patients had sequential biopsies taken, we demonstrate that measurement of T-cell subsets and effector function, specifically CD45RO expression, throughout chemotherapy predicts risk of metastatic relapse. Furthermore, we identified the tumor inherent interferon regulatory factor IRF9 as a marker of active intratumoral type I and II interferon (IFN) signaling and reduced risk of distant relapse. Functional implications of tumor intrinsic IFN signaling were demonstrated using an immunocompetent mouse model of TNBC, where enhanced type I IFN signaling increased anti-tumor immunity and metastasis-free survival post-chemotherapy. Using two independent adjuvant cohorts we were able to validate loss of IRF9 as a poor prognostic biomarker pre-chemotherapy. Thus, IRF9 expression may offer early insight into TNBC patient prognosis and tumor heat, allowing for identification of patients that are unlikely to respond to chemotherapy alone and could benefit from further immune-based therapeutic intervention.

Research paper thumbnail of Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study

Research paper thumbnail of Propagation-Based Phase-Contrast CT of the Breast Demonstrates Higher Quality Than Conventional Absorption-Based CT Even at Lower Radiation Dose

Research paper thumbnail of High-Resolution X-ray Phase-Contrast 3D Imaging of Breast Tissue Specimens as a Possible Adjunct to Histopathology

IEEE transactions on medical imaging, Jan 11, 2018

THistopathological analysis is the current gold standard in breast cancer diagnosis and managemen... more THistopathological analysis is the current gold standard in breast cancer diagnosis and management, however, as imaging technology improves, the amount of potential diagnostic information that may be demonstrable radiologically should also increase. We aimed to evaluate the potential clinical usefulness of 3D phase-contrast micro-computed tomography (micro-CT) imaging at high spatial resolutions as an adjunct to conventional histological microscopy. Ten breast tissue specimens, 2 mm in diameter, were scanned at the SYRMEP beamline of the Elettra Synchrotron using the propagation-based phase-contrast micro-tomography method. We obtained 1.2 ìm pixel size images, which were analysed and compared with corresponding histological sections examined under light microscopy. To evaluate the effect of spatial resolution on breast cancer diagnosis, scans with 4 different pixel sizes were also performed. Our comparative analysis revealed that high-resolution images can enable, at a near-histolo...

Research paper thumbnail of Advantages of breast cancer visualization and characterization using synchrotron radiation phase-contrast tomography

Journal of synchrotron radiation, 2018

The aim of this study was to highlight the advantages that propagation-based phase-contrast compu... more The aim of this study was to highlight the advantages that propagation-based phase-contrast computed tomography (PB-CT) with synchrotron radiation can provide in breast cancer diagnostics. For the first time, a fresh and intact mastectomy sample from a 60 year old patient was scanned on the IMBL beamline at the Australian Synchrotron in PB-CT mode and reconstructed. The clinical picture was described and characterized by an experienced breast radiologist, who underlined the advantages of providing diagnosis on a PB-CT volume rather than conventional two-dimensional modalities. Subsequently, the image quality was assessed by 11 breast radiologists and medical imaging experts using a radiological scoring system. The results indicate that, with the radiation dose delivered to the sample being equal, the accuracy of a diagnosis made on PB-CT images is significantly higher than one using conventional techniques.

Research paper thumbnail of Immunoglobulin-G4 related mastitis: A case report

International journal of surgery case reports, 2017

IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literatur... more IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literature to date. Organs that are affected with IgG4-related disease (IgG4-RD) all share the same histopathological hallmarks consisting of dense lymphocytic infiltration, storiform fibrosis and obliterative phlebitis. This case report highlights a case of IgG4-RM found incidentally in a 52-year-old woman during a routine breast screen and it explores the current literature about IgG4-RM and IgG4-RD. IgG4-RM and IgG4-RD, in general, is a new entity in the field of medicine and its aetiology is not well understood. In the literature, IgG4-RM often presents as a painless palpable breast lump in isolation or with other systemic manifestations. IgG4-RM is considered benign and has excellent prognosis post-conservative treatment with steroid or surgical excision. IgG4-RM is diagnosed exclusively on histological analysis. It is hard to distinguish IgG4-RD from malignant breast lesions purely on clini...

Research paper thumbnail of Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin

Australian and New Zealand Journal of Surgery, Mar 1, 2002

Background: Unlike other cancers, breast cancer does not occur at increased frequency in renal tr... more Background: Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied. Methods: The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year. Results: In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25-70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25-18.5 years). Eighty-seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had 'dense mammograms', all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study. Conclusion: The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.

Research paper thumbnail of Mapping structural changes in breast tissue disease using x-ray scattering

Spread of invasive carcinoma throughout breast tissue is believed to occur at supramolecular leve... more Spread of invasive carcinoma throughout breast tissue is believed to occur at supramolecular levels, beyond the range of standard histopathology identification. Small angle x-ray scattering (SAXS) is capable of characterizing the structural properties of collagen and tissue found in the breast at the scale of tens to hundreds of nanometers. Fifty-six patients who were treated with wide-local excision or mastectomy had tissue biopsy samples analyzed at 2 cm intervals along two perpendicular axes over their excised mass, up to 6 cm away from the primary site of the tumor. Two SAXS parameters, the integrated amorphous scatter and the third order collagen axial d spacing, showed significant differences between the center (0 cm) and distant tissues (2, 4, or 6 cm from the primary lesion). There was no evidence of directional trends (superior, inferior, or lateral sides of the nipple) of these two parameters over the breast. Mapping of these two variables over a two-dimensional grid showed good matching with independent histopathology diagnosis. These results suggest that SAXS may be capable of identifying areas of invasion or directional spread of disease as well as providing more information at the supramolecular level for aiding tissue diagnosis.

Research paper thumbnail of Breast problems

Hunt & Marshall's Clinical Problems in Surgery, 2010

Research paper thumbnail of Integument problems

Hunt & Marshall's Clinical Problems in Surgery, 2010

Research paper thumbnail of Resurveying micrometastases in breast cancer: have we now turned the corner?

ANZ Journal of Surgery, 2014

Research paper thumbnail of Sentinel node micrometastases in breast cancer: a survey of Australian and New Zealand breast surgeons

ANZ Journal of Surgery, 2012

Research paper thumbnail of Changes in ALDEHYDE DEHYDROGENASE-1 expression during neoadjuvant chemotherapy predict outcome in locally advanced breast cancer

Breast Cancer Research, 2014

Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can improve operabilit... more Although neoadjuvant chemotherapy (NAC) for locally advanced breast cancer can improve operability and local disease control, there is a lack of reliable biomarkers that predict response to chemotherapy or long-term survival. Since expression of aldehyde dehydrogenase-1 (ALDH1) is associated with the stem-like properties of self-renewal and innate chemoresistance in breast cancer, we asked whether expression in serial tumor samples treated with NAC could identify women more likely to benefit from this therapy. Women with locally advanced breast cancer were randomly assigned to receive four cycles of anthracycline-based chemotherapy, followed by four cycles of taxane therapy (Arm A), or the same regimen in reverse order (Arm B). Tumor specimens were collected at baseline, after four cycles, and then at surgical resection. ALDH1 expression was determined by immunohistochemistry and correlated with tumor response using Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test while Kaplan-Meier method was used to calculate survival. A hundred and nineteen women were enrolled into the study. Fifty seven (48%) were randomized to Arm A and 62 (52%) to Arm B. Most of the women (90%) had ductal carcinoma and 10% had lobular carcinoma. Of these, 26 (22%) achieved a pathological complete response (pCR) after NAC. There was no correlation between baseline ALDH1 expression and tumor grade, stage, hormone receptor, human epidermal growth factor receptor 2 (HER2) status and Ki67 index. ALDH1 negativity at baseline was significantly associated with pCR (P = 0.004). The presence of ALDH1(+) cells in the residual tumor cells in non-responding women was strongly predictive of worse overall survival (P = 0.024). Moreover, serial analysis of specimens from non-responders showed a marked increase in tumor-specific ALDH1 expression (P = 0.028). Overall, there was no survival difference according to the chemotherapy sequence. However, poorly responding tumours from women receiving docetaxel chemotherapy showed an unexpected significant increase in ALDH1 expression. ALDH1 expression is a useful predictor of chemoresistance. The up-regulation of ALDH1 after NAC predicts poor survival in locally advanced breast cancer. Although the chemotherapy sequence had no effect on overall prognosis, our results suggest that anthracycline-based chemotherapy may be more effective at targeting ALDH1(+) breast cancer cells. ACTRN12605000588695.

Research paper thumbnail of Small Angle X-Ray Scattering Signatures for Breast Cancer Detection: Direct Comparison of Synchrotron and Laboratory X-Ray Sources

IFMBE Proceedings, 2009

ABSTRACT Scattering signatures from human breast tissue acquired on a synchrotron x-ray source an... more ABSTRACT Scattering signatures from human breast tissue acquired on a synchrotron x-ray source and a laboratory instrument have been directly compared. We have previously established that the amorphous scatter intensity is extremely sensitive to disease status, able to detect the molecular changes in healthy tissue from patients with verified disease before the conventional histological markers of cancer are visible. SAXS images of tissue samples from 130 patients were imaged on a synchrotron source, and matched samples from 66 of these patients were also imaged on a laboratory source. The results indicate that not only does the integrated amorphous scattering intensity increase with disease severity for both sources, but that the size of the predominant scatterers also appears to decrease with disease progression. KeywordsBreast cancer-extra-cellular matrix-x-ray scattering

Research paper thumbnail of Classification of breast tissue using a laboratory system for small-angle x-ray scattering (SAXS)

Physics in Medicine and Biology, 2011

Structural changes in breast tissue at the nanometre scale have been shown to differentiate betwe... more Structural changes in breast tissue at the nanometre scale have been shown to differentiate between tissue types using synchrotron SAXS techniques. Classification of breast tissues using information acquired from a laboratory SAXS camera source could possibly provide a means of adopting SAXS as a viable diagnostic procedure. Tissue samples were obtained from surgical waste from 66 patients and structural components of the tissues were examined between q = 0.25 and 2.3 nm(-1). Principal component analysis showed that the amplitude of the fifth-order axial Bragg peak, the magnitude of the integrated intensity and the full-width at half-maximum of the fat peak were significantly different between tissue types. A discriminant analysis showed that excellent classification can be achieved; however, only 30% of the tissue samples provided the 16 variables required for classification. This suggests that the presence of disease is represented by a combination of factors, rather than one specific trait. A closer examination of the amorphous scattering intensity showed not only a trend of increased scattering intensity with disease severity, but also a corresponding decrease in the size of the scatterers contributing to this intensity.

Research paper thumbnail of X-ray scattering for classifying tissue types associated with breast disease

Medical Physics, 2008

Collagen types I and III can be characterized at the molecular level (at the tens to hundreds of ... more Collagen types I and III can be characterized at the molecular level (at the tens to hundreds of nanometers scale) using small angle x-ray scattering (SAXS). Although collagen fibril structural parameters at this length scale have shown differences between diseased and nondiseased breast tissues, a comprehensive analysis involving a multitude of features with a large (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50) patient cohort has not previously been investigated. Breast tissue samples were excised from 80 patients presenting with either a breast lump or reduction mammoplasty. From these, invasive carcinoma, benign tissue, and normal parenchyma were analyzed. Parameters related to collagen structure, including longitudinal (axial) and lateral (equatorial) features, polar angle features, total scattering intensity, and tissue heterogeneity effects, were extracted from the SAXS patterns and examined. The amplitude of the third-order axial peak and the total scattering intensity (amorphous scatter) showed the most separation between tissue groups and a classification model using these two parameters demonstrated an accuracy of over 95% between invasive carcinoma and mammoplasty patients. Normal tissue taken from disease-free patients (mammoplasty) and normal tissue taken from patients with presence of disease showed significant differences, suggesting that SAXS may provide different diagnostic information from that of conventional histopathology.

Research paper thumbnail of Fourier transform infrared imaging and small angle x-ray scattering as a combined biomolecular approach to diagnosis of breast cancer

Medical Physics, 2008

Fourier transform infrared (FTIR) microspectroscopic imaging and small angle x-ray scattering (SA... more Fourier transform infrared (FTIR) microspectroscopic imaging and small angle x-ray scattering (SAXS) were combined to investigate the supramolecular structure of collagen from 27 tissue sections from patients undergoing mastectomy, excisional biopsy, or mammoplasty. Both techniques were correlated by matching the scattering profile from the SAXS data with the integrated area of the infrared collagen region (1300-1180 cm(-1)). The FTIR spectral profiles and multivariate analysis of various tissue components showed consistent differences between all major tissue components, particularly between cancer and normal tissue cells. Analysis of the SAXS data revealed broad differences between cancer and normal tissue, but were inconclusive due to the small sample size. Parameters were extracted from each technique in relation to their characterization of collagen to reveal a good correlation between the two techniques, which diagnostically parallels with gold-standard Hematoxylin and Eosin (H&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;E) stained sections. The results show that the integrated area of collagen region in the FTIR spectrum for cancerous samples is greater than that for noncancerous samples indicating collagen disorder. This supports the notion that collagen is structurally disrupted in cancer tissue consistent with the interpretation of the SAXS data. Overall, both these techniques successfully distinguished cancer from normal breast tissue. Integration of these two techniques was able to better segregate cancer as well as provide a more complete understanding of the differences in collagen on all structural levels during breast cancer development.