| Expert Perspectives |
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Lessons from a Woman Who Beat the Odds
Approximately a year ago, when I became editor-in-chief of Breast Diseases: A Year Book® Quarterly, I had the idea of including an editorial from a breast cancer patient, family member, or advocate in...
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Thomas A. Buchholz
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120
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Reflections on Breast Cancer
Forty-one years ago, on the cusp between adolescence and young womanhood, I was stunned when a rather aggressive metastatic tumor interrupted my life. Fifteen years after my initial operation, my surg...
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Ellen Cruse Metz
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120-125
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Nipple-Sparing Mastectomy: Are We Compromising Oncologic Safety for Cosmesis?
Randomized trials, such as the National Surgical Adjuvant Breast and Bowel Project B-04 and B-06 clinical trials, provided a foundation for a minimally invasive approach to the surgical management of ...
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Bridget A. Oppong,
Virgilio Sacchini
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126-128
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Is Breast Conservation Therapy Under Siege?
After the National Institutes of Health Consensus Statement was released in 1990, the rates of breast-conserving surgery (BCS) increased in the United States throughout the 1990s and 2000s. However, i...
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Todd M. Tuttle
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128-131
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The Evolution and Future of Dedicated Breast CT
Breast computed tomography (CT) is not a new idea, but perhaps now its time has come. Recently, there has been renewed interest in this modality for a number of reasons. One reason is that 3-dimension...
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Avice M. O'Connell
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131-133
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| General Issues in Breast Cancer |
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Author(s) |
Pages |
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Characteristics and Outcomes of Breast Cancer in Women With and Without a History of Radiation for Hodgkin's Lymphoma: A Multi-Institutional, Matched Cohort Study: Elkin EB, Klem ML, Gonzales AM, et al (Memorial Sloan Kettering Cancer Ctr, NY; Exempla St Joseph Hosp, Denver, CO; et al) J Clin Oncol 29:2466-2473, 2011§
To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL).
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B.S. Dabaja
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134-135
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Outcomes of positron emission tomography–staged clinical N3 breast cancer treated with neoadjuvant chemotherapy, surgery, and radiotherapy: Park HJ, Shin KH, Cho KH, et al (Seoul Natl Univ College of Medicine, Korea; Natl Cancer Ctr, Goyang, Korea) Int J Radiat Oncol Biol Phys 81:e689-e695, 2011§
To evaluate the treatment outcome and efficacy of regional lymph node irradiation after neoadjuvant chemotherapy (NCT) and surgery in positron emission tomography (PET)–positive clinical N3 (cN3) brea...
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G.V. Walker,
T.A. Buchholz
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135-136
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| Epidemiology |
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Author(s) |
Pages |
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Breast Cancer Incidence Rates in U.S. Women Are No Longer Declining: DeSantis C, Howlader N, Cronin KA, et al (American Cancer Society, Atlanta, GA; Natl Cancer Inst, Bethesda, MD) Cancer Epidemiol Biomarkers Prev 20:733-739, 2011§
Several publications reported breast cancer incidence rates continued to decrease among white women, following the decline of about 7% from 2002 to 2003. However, none of these reports exclusively exa...
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G.L. Smith
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137-138
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Poorer Survival Outcomes for Male Breast Cancer Compared with Female Breast Cancer May Be Attributable to In-Stage Migration: Gnerlich JL, Deshpande AD, Jeffe DB, et al (Washington Univ School of Medicine, St Louis, MO; Saint Louis Univ School of Public Health, MO) Ann Surg Oncol 18:1837-1844, 2011§
Male breast cancer accounts for less than 1% of all breast cancers, yet males have a worse prognosis than females with breast cancer.
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J.F. De Los Santos
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138-140
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Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: Metcalfe K, Gershman S, Lynch HT, et al (Univ of Toronto, Canada; Creighton Univ School of Medicine, Omaha, NE; et al) Br J Cancer 104:1384-1392, 2011§
The objective of this study was to estimate the risk of contralateral breast cancer in BRCA1 and BRCA2 carriers; and measure the extent to which host, family history, and cancer treatment-related fact...
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S. Abouharb,
J.K. Litton
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140-141
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| Diagnostic Imaging |
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Article Title |
Author(s) |
Pages |
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Preoperative Ultrasound-Guided Needle Biopsy of Axillary Nodes in Invasive Breast Cancer: Meta-Analysis of its Accuracy and Utility in Staging the Axilla: Houssami N, Ciatto S, Turner RM, et al (Univ of Sydney, Australia; Breast Cancer Screening Program, Padua, Veneto Region, Italy; et al) Ann Surg 254:243-251, 2011§
Systematic evidence synthesis of ultrasound-guided needle biopsy (UNB) of axillary nodes in breast cancer.
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M. Itani,
G.J. Whitman
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142-143
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Screening Breast MR Imaging in Women with a History of Chest Irradiation: Sung JS, Lee CH, Morris EA, et al (Memorial Sloan-Kettering Cancer Ctr, NY) Radiology 259:65-71, 2011§
To assess the utility of screening magnetic resonance (MR) imaging in detecting otherwise occult breast cancers in women with a history of radiation therapy to the chest.
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K.E. Hoffman,
G.J. Whitman
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143-144
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Effectiveness of Alternating Mammography and Magnetic Resonance Imaging for Screening Women With Deleterious BRCA Mutations at High Risk of Breast Cancer: Le-Petross HT, Whitman GJ, Atchley DP, et al (The Univ of Texas MD Anderson Cancer Ctr, Houston) Cancer 117:3900-3907, 2011§
Magnetic resonance imaging (MRI) has been used to supplement screening mammography and clinical breast examination (CBE) in women who are at high risk of developing breast cancer. In this study, the a...
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L. Margolies
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144-145
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Background Parenchymal Enhancement at Breast MR Imaging and Breast Cancer Risk: King V, Brooks JD, Bernstein JL, et al (Memorial Sloan-Kettering Cancer Ctr, NY) Radiology 260:50-60, 2011§
To examine the relationships between breast cancer and both amount of fibroglandular tissue (FGT) and level of background parenchymal enhancement (BPE) at magnetic resonance (MR) imaging.
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R.J. Brenner
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145-147
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Use of BI-RADS 3–Probably Benign Category in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial: Baum JK, Hanna LG, Acharyya S, et al (Cambridge Health Alliance, MA; Brown Univ, Providence, RI; et al) Radiology 260:61-67, 2011§
To determine (a) how often the Breast Imaging Reporting and Data System (BI-RADS) category 3 was used in the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screenin...
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R.D. Rosenberg,
M.N. Linver
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147-148
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Breast Imaging Training and Attitudes: Update Survey of Senior Radiology Residents: Bassett LW, Bent C, Sayre JW, et al (David Geffen School of Medicine at UCLA) AJR Am J Roentgenol 197:263-269, 2011§
The purpose of this study was to investigate the training and attitudes of senior residents regarding breast imaging.
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D.M. Farria
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148-150
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Accuracy of Screening Mammography in Older Women: Sinclair N, Littenberg B, Geller B, et al (Brown Univ, Providence, RI; Univ of Vermont School of Medicine, Burlington; Univ of Vermont, Burlington; et al) AJR Am J Roentgenol 197:1268-1273, 2011§
The objective of our study was to determine the accuracy and cancer detection rate of screening mammography in women as they age.
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C.J. D'Orsi
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150-151
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Performance of computer-aided detection applied to full-field digital mammography in detection of breast cancers: Sadaf A, Crystal P, Scaranelo A, et al (Mount Sinai Hosp, Toronto, Ontario, Canada; Princess Margaret Hosp, Toronto, Ontario, Canada; et al) Eur J Radiol 77:457-461, 2011§
The aim of this retrospective study was to evaluate performance of computer-aided detection (CAD) with full-field digital mammography (FFDM) in detection of breast cancers.
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E.A. Sickles
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151-154
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| Pathology |
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Article Title |
Author(s) |
Pages |
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A comparative analysis of core needle biopsy and final excision for breast cancer: histology and marker expression: Ough M, Velasco J, Hieken TJ (NorthShore Univ Healthcare System, Skokie, IL) Am J Surg 201:685-687, 2011§
Core needle biopsy (CNB) is used increasingly not only to diagnose breast cancer, but to determine tumor histology, grade and marker expression, select neoadjuvant therapy, and predict sentinel lymph ...
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A. Sahin
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154-155
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Androgen receptor expression in breast cancer in relation to molecular phenotype: results from the Nurses' Health Study: Collins LC, Cole KS, Marotti JD, et al (Beth Israel Deaconess Med Ctr and Harvard Med School, Boston, MA; Dartmouth-Hitchcock Med Ctr, Lebanon, NH) Mod Pathol 24:924-931, 2011§
Previous studies have demonstrated that androgen receptor is expressed in many breast cancers, but its expression in relation to the various breast cancer subtypes as defined by molecular profiling ha...
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L. Huo
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155-156
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HER2 Protein and Gene Variation between Primary and Metastatic Breast Cancer: Significance and Impact on Patient Care: Fabi A, Di Benedetto A, Metro G, et al (Regina Elena Cancer Inst, Rome, Italy) Clin Cancer Res 17:2055-2064, 2011§
To analyze HER2 status in primary breast cancer (PBC) compared with correspondent metachronous metastases and to investigate whether BC phenotype may be predictive of change in HER2 expression.
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M.Z. Gilcrease
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157-158
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| Prognostic Factors |
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Article Title |
Author(s) |
Pages |
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Lymph Node Ratio: A Proposed Refinement of Current Axillary Staging in Breast Cancer Patients: Schiffman SC, McMasters KM, Scoggins CR, et al (Univ of Louisville, KY; et al) J Am Coll Surg 213:45-53, 2011§
The optimal method for classifying lymph node (LN) status in breast cancer patients is unknown. We sought to determine if LN ratio (LNR) improves axillary staging.
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J. Canavan,
P.T. Truong
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158-159
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Effect of HER2 status on risk of recurrence in women with small, node-negative breast tumours: Tanaka K, Kawaguchi H, Nakamura Y, et al (Natl Kyushu Cancer Centre, Minami-ku, Fukuoka, Japan) Br J Surg 98:1561-1565, 2011§
Adjuvant trastuzumab for small, node-negative, human epidermal growth factor receptor 2 (HER2)-positive breast cancer remains controversial. The purpose of this study was to investigate the risk of re...
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R. Theriault
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159-160
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Molecular serum portraits in patients with primary breast cancer predict the development of distant metastases: Carlsson A, Wingren C, Kristensson M, et al (Lund Univ, Sweden; et al) Proc Natl Acad Sci U S A 108:14252-14257, 2011§
The risk of distant recurrence in breast cancer patients is difficult to assess with current clinical and histopathological parameters, and no validated serum biomarkers currently exist. Using a recen...
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F.J. Esteva
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160-161
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Breast cancer expression of YKL-40 correlates with tumour grade, poor differentiation, and other cancer markers: Shao R, Cao QJ, Arenas RB, et al (Pioneer Valley Life Sciences Inst, Springfield, MA; Tufts Univ, Springfield, MA; et al) Br J Cancer 105:1203-1209, 2011§
Serum levels of a secreted glycoprotein YKL-40 are elevated in patients with a wide range of cancers including breast, colorectal, and ovarian cancers. Furthermore, these increased levels correlate wi...
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C.E. Pelloski
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161-162
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| Non-Invasive Cancer |
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Article Title |
Author(s) |
Pages |
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Tamoxifen added to radiotherapy and surgery for the treatment of ductal carcinoma in situ of the breast: A meta-analysis of 2 randomized trials: Petrelli F, Barni S (Azienda Ospedaliera Treviglio-Caravaggio, Bergamo, Italy) Radiother Oncol 100:195-199, 2011§
Surgical excision with adequate margins is the treatment of choice for ductal, in situ carcinoma of the breast (DCIS). The addition of radiotherapy (RT) halved local in situ and invasive recurrence. T...
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F. Cadiz,
H. Kuerer
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163-164
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Accelerated partial breast irradiation for pure ductal carcinoma in situ: Park SS, Grills IS, Chen PY, et al (William Beaumont Hosp, Royal Oak, MI) Int J Radiat Oncol Biol Phys 81:403-408, 2011§
To report outcomes for ductal carcinoma in situ (DCIS) treated with breast-conserving therapy using accelerated partial breast irradiation (APBI).
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L.W. Cuttino
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164-165
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Ductal Carcinoma in Situ at Core-Needle Biopsy: Meta-Analysis of Underestimation and Predictors of Invasive Breast Cancer: Brennan ME, Turner RM, Ciatto S, et al (Univ of Sydney, New South Wales, Australia) Radiology 260:119-128, 2011§
To perform a meta-analysis to report pooled estimates for underestimation of invasive breast cancer (where core-needle biopsy [CNB] shows ductal carcinoma in situ [DCIS] and excision histologic examin...
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G. Hermann
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165-166
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| Surgical Treatment |
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Article Title |
Author(s) |
Pages |
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Subsets of women with close or positive margins after breast-conserving surgery with high local recurrence risk despite breast plus boost radiotherapy: Lupe K, Truong PT, Alexander C, et al (British Columbia Cancer Agency, Vancouver, Canada; et al) Int J Radiat Oncol Biol Phys 81:e561-e568, 2011§
(1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk ...
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A. Recht
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166-169
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Liver resection and local ablation of breast cancer liver metastases – A systematic review: Bergenfeldt M, Jensen BV, Skjoldbye B, et al (Univ of Copenhagen, Herlev, Denmark) Eur J Surg Oncol 37:549-557, 2011§
To analyze surgical treatment of breast cancer liver metastases (BCLM) regarding selection criteria, outcome and prognostic parameters.
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T.A. Aloia
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169-171
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Breast Cancer Surgery Trend Changes Since the Introduction of BRCA1/2 Mutation Screening: A Retrospective Cohort Analysis of 158 Mutation Carriers Treated at a Single Institution: Mislowsky A, Domchek S, Stroede C, et al (Univ of Pennsylvania, Philadelphia) Ann Surg Oncol 18:745-751, 2011§
Bilateral mastectomy in women diagnosed with unilateral breast cancer is on the rise in the USA. One contributing factor is increased awareness of contralateral breast cancer risk. Positive testing fo...
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D. Hemel,
M. Robson
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171-172
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Multidisciplinary Considerations in the Implementation of the Findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 Study: A Practice-Changing Trial: Caudle AS, Hunt KK, Kuerer HM, et al (The Univ of Texas MD Anderson Cancer Ctr, Houston) Ann Surg Oncol 18:2407-2412, 2011§
The American College of Surgeons Oncology Group (ACOSOG) reported the results of the Z0011 trial. This trial was designed to assess the impact of completion axillary lymph node dissection (cALND) on l...
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R. Jagsi
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172-174
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| Sentinel Node Biopsy |
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Article Title |
Author(s) |
Pages |
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Sentinel Lymph Node Biopsy in Multicentric Breast Cancer: Five-Year Results in a Large Series from a Single Institution: Gentilini O, Veronesi P, Botteri E, et al (European Inst of Oncology, Milano, Italy; et al) Ann Surg Oncol 18:2879-2884, 2011§
This study was designed to present the 5-year results of patients with multicentric breast cancer who underwent sentinel lymph node biopsy (SLNB) in a single institution.
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T.E. Grotz,
J.C. Boughey
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174-176
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| Radiation Therapy |
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Article Title |
Author(s) |
Pages |
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Age, Comorbidity, and Breast Cancer Severity: Impact on Receipt of Definitive Local Therapy and Rate of Recurrence among Older Women with Early-Stage Breast Cancer: Field TS, Bosco JLF, Prout MN, et al (Meyers Primary Care Inst, Worcester, MA; Boston Univ Med Ctr, MA; Boston Univ School of Public Health, MA; et al) J Am Coll Surg 213:757-765, 2011§
The definitive local therapy options for early-stage breast cancer are mastectomy and breast-conserving surgery followed by radiation therapy. Older women and those with comorbidities frequently recei...
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J.M. Albert,
B.D. Smith
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176-177
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Early-stage young breast cancer patients: Impact of local treatment on survival: Bantema-Joppe EJ, De Munck L, Visser O, et al (Univ of Groningen, The Netherlands; Comprehensive Cancer Ctr North East, Groningen/Enschede, The Netherlands; Comprehensive Cancer Ctr Amsterdam, The Netherlands) Int J Radiat Oncol Biol Phys 81:e553-e559, 2011§
In young women, breast-conserving therapy (BCT), i.e., lumpectomy followed by radiotherapy, has been associated with an increased risk of local recurrence. Still, there is insufficient evidence that B...
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U. Mahmood
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178-179
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Is α/β for breast cancer really low? Qi XS, White J, Li XA (Univ of Colorado Denver, Aurora; Med College of Wisconsin, Milwaukee) Radiother Oncol 100:282-288, 2011§
Low α/β ratio for breast cancer has drawn a growing interest for exploring hypofractionation for breast irradiation. This work is to confirm the low α/β ratio based on large randomized clinical trials...
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G.M. Freedman
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179-182
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Fractionation for whole breast irradiation: An American Society for Radiation Oncology (ASTRO) evidence-based guideline: Smith BD, Bentzen SM, Correa CR, et al (Univ of Texas, MD Anderson Cancer Ctr, Houston; Univ of Wisconsin School of Medicine and Public Health, Madison; Univ of Michigan, Ann Arbor; et al) Int J Radiat Oncol Biol Phys 81:59-68, 2011§
In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with c...
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C.E. Fasola,
K. Horst
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182-183
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Do Radiation Use Disparities Influence Survival in Patients With Advanced Breast Cancer? Martinez SR, Tseng WH, Canter RJ, et al (Univ of California Davis, Sacramento) Cancer 118:196-204, 2012§
The authors previously identified racial/ethnic disparities in the use of radiation therapy (RT) in patients with advanced breast cancer (BC). They hypothesized that disparities in the use of RT were ...
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G.L. Smith
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184
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Outcomes of node-negative breast cancer 5 centimeters and larger treated with and without postmastectomy radiotherapy: Goulart J, Truong P, Woods R, et al (Univ of British Columbia, Vancouver, Canada; British Columbia Cancer Agency, Vancouver, Canada) Int J Radiat Oncol Biol Phys 80:758-764, 2011§
The role of adjuvant postmastectomy radiotherapy (PMRT) remains controversial for the rare presentation of pT3pN0cM0 breast cancer. The present analysis examined locoregional recurrence (LRR) and brea...
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S.R. Floyd
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185-187
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Twelve-year clinical outcomes and patterns of failure with accelerated partial breast irradiation versus whole-breast irradiation: Results of a matched-pair analysis: Shah C, Antonucci JV, Wilkinson JB, et al (William Beaumont Hosp, MI) Radiother Oncol 100:210-214, 2011§
To compare 12-year outcomes of accelerated partial breast irradiation (APBI) versus whole-breast irradiation (WBI) in patients treated with breast conservation.
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B.D. Smith
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187-188
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Breast cancer patients receiving postoperative radiotherapy: Distress, depressive symptoms and unmet needs of psychosocial support: Luutonen S, Vahlberg T, Eloranta S, et al (Univ of Turku, Finland; Central Finland Central Hosp, Jyväskylä; et al) Radiother Oncol 100:299-303, 2011§
The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and di...
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R. Gopal
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188-189
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Irradiation effect after mastectomy on breast cancer recurrence in patients presenting with locally advanced disease: Taras AR, Thorpe JD, Morris AD, et al (Swedish Med Ctr, Seattle, WA; Fred Hutchinson Cancer Res Ctr, Seattle, WA) Am J Surg 201:605-610, 2011§
Current guidelines recommend postmastectomy irradiation (PMI) for patients with tumors >5cm and/or ≥4 positive lymph nodes. This study evaluates the effect of PMI on recurrence and survival within ...
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W.A. Hall,
M.A. Torres
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189-190
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| Hormonal Therapy |
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Article Title |
Author(s) |
Pages |
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Results of the CONFIRM Phase III Trial Comparing Fulvestrant 250 mg With Fulvestrant 500mg in Postmenopausal Women With Estrogen Receptor–Positive Advanced Breast Cancer: Di Leo A, Jerusalem G, Petruzelka L, et al (Hosp of Prato, Italy; Centre Hospitalier Universitaire Sart Tilman, Liége, Belgium; AZ. Klina, Brasschaat, Belgium; et al) J Clin Oncol 28:4594-4600, 2010§
We compared fulvestrant 500mg regimen with the approved dose of fulvestrant 250mg per month for treatment of postmenopausal women with estrogen receptor–positive advanced breast cancer who experienced...
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V.C. Jordan
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190-191
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Impact of Body Mass Index on the Efficacy of Endocrine Therapy in Premenopausal Patients With Breast Cancer: An Analysis of the Prospective ABCSG-12 Trial: Pfeiler G, Königsberg R, Fesl C, et al (Med Univ of Vienna, Austria; Applied Cancer Res–Institution for Translational Res Vienna (ACR-ITR Vienna), Austria; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; et al) J Clin Oncol 29:2653-2659, 2011§
Aromatase inhibitors are effective as endocrine treatment for patients with hormone receptor–positive breast cancer. According to the hypothesis that overweight patients have higher levels of aromatas...
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I. Sestak
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191-192
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| Cosmetic and Reconstructive Surgery |
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Article Title |
Author(s) |
Pages |
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Disparities in Reconstruction Rates After Mastectomy: Patterns of Care and Factors Associated with the Use of Breast Reconstruction in Southern California: Kruper L, Holt A, Xu XX, et al (City of Hope Natl Med Ctr, Duarte, CA) Ann Surg Oncol 18:2158-2165, 2011§
Many factors influence whether breast cancer patients undergo reconstruction after mastectomy. We sought to determine the patterns of care and variables associated with the use of breast reconstructio...
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M.T. Villa
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193-194
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An Analysis of Immediate Postmastectomy Breast Reconstruction Frequency Using the Surveillance, Epidemiology, and End Results Database: Agarwal S, Pappas L, Neumayer L, et al (Univ of Chicago, IL; Univ of Utah School of Medicine, Salt Lake City) Breast J 17:352-358, 2011§
Mastectomy is used to treat one third of the nearly 180,000 women diagnosed with breast cancer in the United States annually. In this study, we use population-level data from multiple years of the Sur...
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D.W. Chang
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194
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| Economic, Legal, and Social Issues |
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Article Title |
Author(s) |
Pages |
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Cost-Effectiveness of Chemoprevention of Breast Cancer Using Tamoxifen in a Postmenopausal US Population: Noah-Vanhoucke J, Green LE, Dinh TA, et al (Archimedes Inc, San Francisco, CA; et al) Cancer 117:3322-3331, 2011§
Previous cost-effectiveness analyses of tamoxifen therapy account for breast cancer risk reduction during active treatment but not for its persistent protective effect after active treatment.
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S. Day,
T.B. Bevers
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195-196
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Economic evaluation of four follow-up strategies after curative treatment for breast cancer: Results of an RCT: Kimman ML, Dirksen CD, Voogd AC, et al (MAASTRO Clinic, Maastricht, The Netherlands; Maastricht Univ Med Centre, The Netherlands; et al) Eur J Cancer 47:1175-1185, 2011§
An economic evaluation was performed alongside a randomised controlled trial (ISRCTN 74071417) investigating the cost-effectiveness of nurse-led telephone follow-up instead of hospital visits, and of ...
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M. Chavez-MacGregor
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197-198
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| Breast-Conserving Therapy |
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Article Title |
Author(s) |
Pages |
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Clinicopathologic Factors of the Recurrent Tumor Predict Outcome in Patients With Ipsilateral Breast Tumor Recurrence: Panet-Raymond V, Truong PT, Alexander C, et al (McGill Univ Health Centre, Montreal, Quebec, Canada; Vancouver Island Centre, British Columbia, Canada; et al) Cancer 117:2035-2043, 2011§
The role of clinicopathologic characteristics of the recurrent tumor in determining survival in a cohort of patients with ipsilateral breast tumor recurrence (IBTR) was investigated.
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S. Krishnamurthy
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198-199
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Predicting Breast Cancer Recurrence Following Breast-Conserving Therapy: A Single-Institution Analysis Consisting of 764 Chinese Breast Cancer Cases: Li S, Yu K-D, Fan L, et al (Fudan Univ, Shanghai, People's Republic of China) Ann Surg Oncol 18:2492-2499, 2011§
The purpose of this study was to identify prognostic factors related to recurrence in women treated with breast-conserving surgery (BCS) and to predict the recurrence following breast-conserving thera...
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J.L. Wagner
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199-200
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