[show abstract][hide abstract] ABSTRACT: A study was conducted to evaluate the sensitivity of computer-aided detection (CAD) with full-field digital mammography in detection of breast cancer, based on mammographic appearance and histopathology. Retrospectively, CAD sensitivity was assessed in total group of 152 cases for subgroups based on breast density, mammographic presentation, lesion size, and results of histopathological examination. The overall sensitivity of CAD was 91 % (139 of 152 cases). CAD detected 100 % (47/47) of cancers manifested as microcalcifications; 98 % (62/63) of those manifested as non-calcified masses; 100 % (15/15) of those manifested as mixed masses and microcalcifications; 75 % (12/16) of those manifested as architectural distortions, and 69 % (18/26) of those manifested as focal asymmetry. CAD sensitivity was 83 % (10/12) for cancers measuring 1-10 mm, 92 % (37/40) for those measuring 11-20 mm, and 92 % (92/100) for those measuring >20 mm. There was no significant difference in CAD detection efficiency between cancers in dense breasts (88 %; 69/78) and those in non-dense breasts (95 %; 70/74). CAD showed a high sensitivity of 91 % (139/152) for the mammographic appearance of cancer and 100 % sensitivity for identifying cancers manifested as microcalcifications. Sensitivity was not influenced by breast density or lesion size. CAD should be effective for helping radiologists detect breast cancer at an earlier stage.
Journal of Digital Imaging 01/2013; · 1.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: An advantage of PET/CT has been demonstrated for diagnosis of several tumor entities. In patients with breast cancer, early diagnosis and accurate restaging of recurrence after surgery is important for selection of the most appropriate therapeutic strategy. Purpose To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG), for follow-up of patients with suspected recurrent breast cancer.
Forty-seven patients with suspected recurrent breast cancer underwent PET/CT. The PET and PET/CT images were interpreted without knowledge of the results of other diagnostic modalities, and compared with each other with reference to the final diagnosis.
Twenty-five (53%) patients suffered tumor recurrence. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT were 96%, 91%, 92%, 95%, and 94%, respectively. In comparison with PET, PET/CT had a higher sensitivity and accuracy (96% vs. 80% and 94% vs. 81%, respectively). The difference in diagnostic accuracy between PET/CT and PET was significant (P < 0.05).
The present findings indicate that PET/CT is an accurate, sensitive and reliable modality for screening and detection of breast cancer recurrence. PET/CT appears to be an effective surveillance tool, as it is able to cover the whole body in a single procedure and shows good performance.
[show abstract][hide abstract] ABSTRACT: There is controversy regarding which of the two biopsy methods, fine-needle aspiration (FNA) or core needle biopsy (CNB), should be routinely employed for diagnosis of breast cancer. The aim of this study was to evaluate the efficacy of FNA compared to CNB and to explore the value of performing both FNA and CNB.
Two hundred eighty-one patients with breast cancer received FNA alone (group 1: n = 182), CNB alone (group 2: n = 56), or a combination of FNA and CNB (group 3: n = 43). In group 3, FNA was combined with CNB because of an inadequate smear of FNA on immediate cytological examination. Subsequently, the patients underwent definitive surgery or open surgical biopsy based on the clinical findings, and the tumors were pathologically confirmed to be noninvasive or invasive breast cancer.
There was no significant difference in the absolute sensitivity between group 1 (93% for FNA alone) and group 2 (86% for CNB alone). In group 3, on the other hand, the absolute sensitivity was significantly improved to 72% when FNA and CNB were combined (P < 0.05), although it was only 42% for FNA alone and 63% for CNB alone.
The absolute sensitivity of FNA was equivalent to that of CNB when excluding patients who were converted from FNA to CNB based on immediate cytological examination. In the latter patients, however, it was improved by combining FNA and CNB. Therefore, these two techniques should be considered complimentary to one another.
Breast Cancer 02/2011; 19(1):23-9. · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: In patients with clinically node-negative breast cancer, diagnosed with palpation and several types of imaging examination, sentinel lymph nodes accurately predict the status of the other axillary nodes, which determine the nature of subsequent adjuvant treatment. In addition, compared with axillary lymph node dissection, sentinel-node biopsy results in less postoperative morbidity, including pain, numbness, swelling, and reduced mobility in the ipsilateral arm.
We analyzed the validity of the sentinel node biopsy procedure using dual-agent injection of blue dye and radioactive colloid performed in our hospital from May 2006 through March 2010. A total of 258 breasts of 253 patients were studied. Simultaneous axillary lymph node dissection was performed only if rapid intraoperative diagnosis identified metastasis in sentinel lymph nodes. The identification rate, accuracy, provisional false-negative rate, which was calculated with data from all 65 patients whose sentinel lymph nodes had metastasis, and axillary recurrence rate of sentinel node biopsy were calculated.
The sentinel node identification rate was 99.2%, and the accuracy of sentinel lymph node status was 98.0%. The provisional false-negative rate was 7.7%. During an observation period averaging 24 months, axillary recurrence was observed in only 1 of 256 cases (0.4%), and there were no cases of parasternal recurrence. In patients who underwent sentinel-node biopsy without axillary lymph node dissection, there was no obvious morbidity.
Our sentinel-node biopsy procedure yielded satisfactory results, which were not inferior to the results of previous clinical trials. Thus, we conclude our sentinel-node biopsy procedure is feasible. If the efficacy and safety of sentinel-node biopsy are confirmed in several large-scale randomized controlled trials in Europe and the United States, sentinel-node biopsy will become a standard surgical technique in the management of clinically node-negative breast cancer.
Journal of Nippon Medical School 01/2011; 78(2):96-100.
[show abstract][hide abstract] ABSTRACT: Mesenteric cysts are rare. In this paper we present a case of a mesenteric cyst in the sigmoid colon of a 3-year-old girl. On the first visit to our department, a smooth-surfaced soft mass approximately 15 cm in diameter was noticed in the right lower abdomen. Although the patient complained of lower abdominal pain, there was no tenderness or guarding. Laboratory tests indicated no abnormality except a slightly increased level of C-reactive protein (2.3 mg/dL). A plain abdominal X-ray film revealed displacement of colonic gas from the right lower abdomen, and abdominal ultrasonography and computed tomography revealed a smooth cystic mass measuring 9.5 x 8.7 x 4.7 cm that contained many internal septa. Because the patient had several symptoms, we performed a surgical operation under general anesthesia. We found a light-red cystic mass, 8.5 x 8.0 x 3.0 cm in size, in the mesentery of the sigmoid colon and surrounding the sigmoid colon, without adhesion to any other organ. We approached the cystic mass from the sigmoid colon and the mesentery of sigmoid colon and completely resected it without complications. The content of the cystic mass was a pale-yellow serous fluid. A cytological examination revealed mainly lymphocytes with reactive mesothelial cells. The resulting pathological diagnosis was a multi-lobular mesenteric cyst. Immunohistochemical staining with D2-40 antibody was positive value along the wall of the cyst, indicating that the cyst was derived from a lymphatic vessel.
Journal of Nippon Medical School 10/2009; 76(5):247-52.
[show abstract][hide abstract] ABSTRACT: The duration of suction drainage in patients undergoing breast cancer surgery is difficult to predict. The uncertainty this poses may complicate the development of a clinical pathway for patients with breast cancer. In this study we attempted to identify factors that may influence the duration of suction drainage in patients undergoing breast cancer surgery.
We examined the relationships between the duration of suction drainage and several clinical factors including type of drainage tube in 60 patients with primary breast cancer who underwent surgical resection at the Nippon Medical School Hospital in 2004 and 2005. The drainage tubes were removed 1 day after the daily drainage volume had decreased to less than 50 mL or on the seventh postoperative day in patients in whom such a decrease did not occur. All patients were discharged from the hospital 1 or 2 days after the drains were removed.
Seroma was observed in all patients. No complications associated with the drainage were observed. The median duration of drainage was 4.5 days, and the range was 2 to 7 days. Univariate analyses revealed significant relationships between the duration of drainage and the following 5 factors: patient age at surgery, body mass index, intraoperative blood loss, operation time, and type of surgery (total breast resection or partial breast resection). Univariate and multivariate analyses showed no significant statistical associations between the duration of drainage and the other factors, including the type of drainage tube.
None of the factors examined was strongly associated with the duration of drainage. This study has shown that any type of drainage tube can be used in breast cancer surgery, in regards to the duration of drainage, and that patient discharge 1 or 2 days after drainage tube removal is appropriate.
Journal of Nippon Medical School 01/2009; 75(6):332-6.
[show abstract][hide abstract] ABSTRACT: Tumour samples from 71 patients with stomach cancer, 41 patients with liver metastasis (group A) and 15 patients each in stages II-IV (group B) and stage I (group C) without liver metastasis were analysed. MAGE-A protein expression was evaluated by immunohistochemistry using a 6C1 monoclonal antibody and MAGE-A10 mRNA expression was detected by highly sensitive in situ hybridisation using a cRNA probe. Expressions of MAGE-A protein and MAGE-A10 mRNA in group A were detected in 65.9 and 80.5%, respectively. Both protein and gene showed significantly higher expression in group A than those in groups B (6.7, 26.7%) and C (0, 0%) (P=0.0003, P=<0.0001, respectively). MAGE-A10 mRNA expression in liver metastasis was found in eight (88.9%) out of nine patients. The concordant rate between MAGE-A family protein expression and MAGE-A10 mRNA expression in the primary sites was 81.7% (P<0.0001). MAGE-A10 gene expression was associated with reduced survival duration. The results of this study suggest that MAGE-A10 is a possible target in active immunotherapy for advanced stomach cancer.
British Journal of Cancer 08/2008; 99(2):350-6. · 5.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report a case of elderly metastatic breast cancer with a complete response to the treatment with XC (X: capecitabine and C: cyclophosphamide). A 78-year-old woman, who presented with left breast cancer, underwent pectoralis-preserving mastectomy when she was 76 years old. Pathological findings were as follows: invasive ductal carcinoma (scirrhous type), pT1c (2.0 cm), n (1/10), ly3, v1, ER (-), PgR (-), HER2: score 1. After one year and a half, a left supraclavicular lymph node metastasis, a left interpectoral lymph node metastasis, and mediastinal lymph nodes metastasis were noted. Capecitabine and cyclophosphamide were administered as first-line chemotherapy. After 8 cycles, all metastases responded, and this therapy is now being continued (19 cycles) on an outpatient basis. The complete response has continued for nine months. XC therapy can be the first-line chemotherapy for elderly metastatic breast cancer patients since it has been effective and no serious side effects have been encountered while maintaining quality of life.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2007; 34(10):1697-700.
[show abstract][hide abstract] ABSTRACT: Some outpatient cancer chemotherapy has been replacing inpatient chemotherapy. A totally implanted venous access system is now available for patients who undergo cancer chemotherapy on an outpatient basis. All eleven outpatients who underwent cancer chemotherapy with this system underwent placement of the port and administration of chemotherapy. Complications were observed in two of these eleven patients (18%). Because a subcutaneous abscess occurred in one patient between the placement of the port and her first chemotherapy session, we had to remove the port system once. Another patient developed fungemia, so we discontinued the system after 95 outpatient chemotherapy sessions. When the infection healed, we set up the system again, and no trouble was observed later in these two cases. According to the patients' survey, all patients were satisfied with outpatient chemotherapy using this system. Therefore, we concluded that this system contributes to enhanced quality of life among outpatients who undergo cancer chemotherapy.
Gan to kagaku ryoho. Cancer & chemotherapy 06/2006; 33(5):639-43.
[show abstract][hide abstract] ABSTRACT: Aim: Omental implantation, a surgical procedure in which a perforated gastric or duodenal ulcer is repaired by drawing and implanting a portion of the omentum into the digestive tract, accelerates ulcer healing and inhibits ulcer recurrence compared with omental patch from clinical results. To clarify these mechanism and differences, we investigated ulcer healing in two groups.Methods: In two groups of rats in which acetic acid-induced gastric ulcers were perforated. Omental implantation was used for repaired in one group and omental patch was employed in the other group. Basic fibroblast growth factor (bFGF) mRNA-positive cells were identified and localized by in situ hybridization. Fibroblast growth factor receptor (FGFR)-positive cells were identified and localized by immunohistochemical analysis.Results: Antiinflammatory and angiogenic activity and accelerated collagen synthesis were seen in the omental implantation group. BFGF mRNA-positive cells (macrophages, fibroblasts, and endothelial cells) and FGFR-positive cells were seen within the omentum, resulting in abundant collagen production and rapid epithelial regeneration. In the omental patch group, extensive neutrophilic infiltration and ulcer recurrence were seen. Few bFGF mRNA-positive cells and FGFR-positive cells were seen within the omentum, resulting to inhibit omentum becoming to be granulation tissue and ulcer healing.Conclusions: These results indicated that omental implantation accelerated ulcer healing, and the presence of bFGF mRNA and FGFR played a significant role in this phenomenon.
[show abstract][hide abstract] ABSTRACT: We detected the relative DNA copy numbers (RCNs) at target loci in patients with stomach cancer with quantitative microsatellite analysis. We additionally clarified the relationship between DNA copy number aberrations and the clinical outcome of the patients.
Fresh frozen samples were obtained from 30 patients who had undergone surgery for stomach cancer. Seven microsatellite loci in chromosomes 8q, 16q, and 20q and one gene-specific locus (ZNF217) were selected as the target loci. The DNA copy number was obtained relatively to a pooled reference consisting of six microsatellite primer sets selected from the regions where few aberrations have been reported in comparative genomic hybridization analysis. On the basis of the TaqMan PCR system, the internal probes used were carrying donor (6-carboxyfluorescein) and acceptor (6-carboxytetramethylrhodamine) fluorescent molecules complementary to CA repeats in the microsatellite markers and to one gene-specific oligomer in the gene-specific marker.
Chromosome 8q gain, 20q gain, and 16q loss were detected in 18 (60.0%), 8 (26.7%), and 13 (43.3%) cases, respectively. Gains in the RCNs of D8S1801 and D8S1724 were most frequently found (36.7%). There was a significant correlation between the loss of D16S3026 and reduced survival duration (P = 0.0158), and the simultaneous aberrations of D8S1801 gain and D16S3026 loss (double marker positive) was significantly associated with reduced survival duration (P = 0.0008). According to Cox proportional hazards model, the double marker positive was a significant and independent factor indicating an unfavorable prognostic factor (relative risk, 17.176; 95% confidence interval, 2.782-106.026; P = 0.0022).
RCN aberrations in tumor tissues determined by quantitative microsatellite analysis enable identification of the prognostic factors that correlate with clinical outcome of the patients with stomach cancer.
Clinical Cancer Research 06/2004; 10(9):3013-9. · 7.84 Impact Factor
[show abstract][hide abstract] ABSTRACT: Radiofrequency ablation (RFA) and microwave coagulation therapy (MCT) have been gaining acceptance as a standard method in the management strategy of liver cancer, for reasons of minimally invasive techniques and effective results. We present our experience of RFA and MCT in patients with liver cancer, and analyze retrospectively the advantages and disadvantages of both of the percutaneous and laparoscopic approaches.
Thirty-two consecutive patients (23 men and 9 women) with 19 hepatocellular carcinomas (HCC), 12 metastatic liver cancers, and recurrent cholangiocellular carcinoma (CCC), were enrolled in this study. Out of these 32 patients, as a prior laparotomy, 19 underwent hepatectomy, colectomy, gastrectomy or cholecystectomy, and 15 were treated with the laparoscopic approach, 17 treated with the percutaneous approach, and 2 treated with the combined approach of those two. All of these procedures were carried out under general anesthesia with ultrasound guidance. Seven and 30 days after these procedures, an assessment helical computed tomography was done.
No sign of the residual tissues was noted in all patients except only one case.
The percutaneous approach was thought to be a more practical and less invasive method regardless previous laparotomy. For the laparoscopic approach, tumors located at the hepatic surface or margin were preferable candidates.
Journal of Hepato-Biliary-Pancreatic Surgery 02/2003; 10(6):425-7. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: We removed a biliary stone and the metallic stent placed two years previously in a patient with benign biliary strictures. An 80-year-old woman who had been inplanted with an expandable metallic stent (EMS) to prevent obstruction by a large common bile duct stone about two years before as an emergency measure in another hospital, was afficted with acute occlusive pyogenic cholangitis (AOPC) and hospitalized in our hospital. After treating the AOPC, we successfully removed the EMS with a cholangioscope and normal biopsy forceps through the percutaneous transhepatic channel under fluoroscopy. The type of the EMS was Accufulex stent. To remove it was easier than expected. Once it started to unravel, it was removed from the common bile duct within a few minutes.
Journal of Nippon Medical School 11/2000; 67(5):380-3.