[Show abstract][Hide abstract] ABSTRACT: Although various strategies have been reported, there are no defined criteria for cosmetic evaluation methods after breast-conserving surgery (BCS). Since Asians tend to have smaller breasts, indistinct inframammary folds, and conspicuous scars, differences in the cosmetic results are expected. So we examined two subjective methods and one objective method to determine the differences, and elements necessary for a cosmetic evaluation after BCS.
Frontal photographs of 190 Japanese were evaluated using the Harris scale (Harris) and the evaluation method proposed by the Japanese Breast Cancer Society Sawai group (Sawai group) as the subjective methods, and the Breast Cancer Conservation Treatment cosmetic results (BCCT.core) as the objective method, respectively. In order to examine the necessary elements for developing a new ideal method, 100 out of 190 were selected and assessed separately by six raters using both the Harris and modified Sawai group methods in the observer assessment. The correlation between the two methods was examined using the Spearman rank-correlation coefficient.
The results of the BCCT.core and the other two methods were clearly different. In the observer assessment, the consensuses of the six raters were evaluated as follows: 27, 27, 26, and 20 cases were evaluated as "excellent," "good," "fair," and "poor," respectively. For the Spearman rank-correlation coefficient, values higher than 0.7 indicated a strong correlation, as seen by the values of 0.909 for the breast shape and 0.345 for the scar. The breast shape accounted for the most significant part of the evaluation, and the scar had very little correlation.
In this study, we recognized a clear difference between the subjective and objective evaluation methods, and identified the necessary elements for cosmetic evaluation. We would like to continue developing an ideal cosmetic evaluation that is similar to subjective one and is independent from raters.
Full-text · Article · Mar 2015 · Journal of Breast Cancer
[Show abstract][Hide abstract] ABSTRACT: An abdominal advancement flap (AAF) is a flap that pulls the elevated abdominal skin up and creates the shape of the inferior portion of the breast by making a neo-inframammary fold. Seven patients underwent remodeling using an AAF or a method combining an AAF with other volume displacement techniques after partial mastectomy. The excision volume ranged from 15% to 35%. AAF with only mobilization of the gland flaps was performed in two cases, with lateral mammoplasty in one case, with the round block technique (RBT) in one case, with a modified RBT in one case, and with medial mammoplasty in two cases. Although one patient treated with a RBT had a partial blood-flow insufficiency of the nipple-areola complex, it improved with conservative treatment. The cosmetic results were found to be excellent in three cases, good in three, and fair in one case.
Full-text · Article · Jun 2013 · Journal of Breast Cancer
[Show abstract][Hide abstract] ABSTRACT: It is often difficult for clinicians to decide correctly on either biopsy or follow-up for breast lesions with masses on ultrasonographic images. The purpose of this study was to develop a computerized determination scheme for histological classification of breast mass by using objective features corresponding to clinicians' subjective impressions for image features on ultrasonographic images. Our database consisted of 363 breast ultrasonographic images obtained from 363 patients. It included 150 malignant (103 invasive and 47 noninvasive carcinomas) and 213 benign masses (87 cysts and 126 fibroadenomas). We divided our database into 65 images (28 malignant and 37 benign masses) for training set and 298 images (122 malignant and 176 benign masses) for test set. An observer study was first conducted to obtain clinicians' subjective impression for nine image features on mass. In the proposed method, location and area of the mass were determined by an experienced clinician. We defined some feature extraction methods for each of nine image features. For each image feature, we selected the feature extraction method with the highest correlation coefficient between the objective features and the average clinicians' subjective impressions. We employed multiple discriminant analysis with the nine objective features for determining histological classification of mass. The classification accuracies of the proposed method were 88.4 % (76/86) for invasive carcinomas, 80.6 % (29/36) for noninvasive carcinomas, 86.0 % (92/107) for fibroadenomas, and 84.1 % (58/69) for cysts, respectively. The proposed method would be useful in the differential diagnosis of breast masses on ultrasonographic images as diagnosis aid.
No preview · Article · Apr 2013 · Journal of Digital Imaging
[Show abstract][Hide abstract] ABSTRACT: A computer-aided diagnosis (CAD) scheme for determining histological classifications of breast masses is expected to be useful for clinicians in making a differential diagnosis. The purpose of this study was to evaluate the usefulness of using the CAD scheme on ultrasonographic images.
The database consisted of 390 breast ultrasonographic images with masses. Three experienced clinicians independently provided subjective ratings on the likelihood of malignancy for each of the 390 masses. Fifty benign masses (25 cysts and 25 fibroadenomas) and 50 malignant masses (25 noninvasive ductal carcinomas and 25 invasive ductal carcinomas) were selected as unknown cases for an observer study based on a stratified randomization method with the ratings. The likelihood of the histological classification in each unknown case was evaluated by the CAD scheme with image features that clinicians commonly use for describing masses. In the observer study, seven observers provided their confidence levels regarding the malignancy of the unknown case before and after viewing the likelihood of the histological classification. The usefulness of the CAD scheme was evaluated with a multireader multicase receiver operating characteristic (ROC) analysis.
The areas under the ROC curves (AUCs) for all observers were improved by use of the CAD scheme. The average AUC increased from 0.716 without to 0.864 with the CAD scheme (P = .006).
The presentation of the likelihood of the histological classification evaluated by the CAD scheme improved the clinicians' performance and therefore would be useful in making a differential diagnosis of masses on ultrasonographic images.
No preview · Article · Apr 2013 · Academic radiology
[Show abstract][Hide abstract] ABSTRACT: Based on the results of Stereotactic Mammotome® Biopsy (ST-MMT), the diagnostic quality of mammographic breast cancer screening and pathological diagnosis was evaluated, and our follow-up policy after ST-MMT was reviewed. During a period of 2 years and 2 months from January 2009 through March 2011, we performed ST-MMT on 240 cases and obtained the following results: (1) All patients whose mammograms were evaluated as Category 5 underwent echo-guided aspiration needle biopsy or mammotome biopsy and were pathologically diagnosed as having cancer. None of these patients underwent ST-MMT. (2) ST-MMT diagnosed benign lesions in 179 patients. Of 98 patients followed up at our hospital, 3 were found to have breast cancer without calcification and the other 95 showed no changes in their mammograms. (3) As a result of ST-MMT, 20 patients were requested to undergo follow-up studies incuding MRI and additional incisions, and non-high-grade DCIS was detected in 3 of them (15%). (4) A final diagnosis of breast cancer was made in 44 patients, who comprised 13% of those with Category 3 and 40% of those with Category 4. More than 80% of these cancers were DCIS. (5) The incidence of breast cancer in terms of morphology and distribution of calcifications was less than 20% among patients with small, round, amorphous or indistinct calcifications and regional calcifications, but as high as 64% among patients with pleomorphic or heterogeneous calcifications and grouped calcifications. Conclusions: DCIS accounted for more than 80% of breast cancers detected at screening, and ST-MMT was shown to be useful for early diagnosis of cancers. In patients whose lesions were diagnosed as benign by ST-MMT and had no other findings, annual screening was thought to be sufficient. In those who were requested to undergo careful follow-up, MRI or additional incisions must be carried out within at least 6 months. Pleomorphic or heterogeneous calcifications and grouped calcifications indicate a high possibility of cancer, and ST-MMT should be performed even if echography shows no abnormal findings.
No preview · Article · Jan 2013 · Nihon Nyugan Kenshin Gakkaishi (Journal of Japan Association of Breast Cancer Screening)
[Show abstract][Hide abstract] ABSTRACT: We introduce a method combining two oncoplastic techniques for breast-conserving reconstruction. The procedure is as follows: first, an extended glandular flap is made by undermining the breast from both the skin and the pectoralis fascia to the upper edge of the breast at the subclavicular area. After modeling the breast mound with the extended glandular flap, an inframammary adipofascial flap is made. The flap is reflected back to the breast area remodeled using the extended glandular flap. After reshaping the breast, the inframammary line is then re-shaped. This method is indicated for patients with breast cancer in the outer portion of the breast, who have small dense breasts, and have undergone a large excision of about 40% of their breast volume. We treated four patients, all of whom had either excellent or good cosmetic results with no fat necrosis.
Full-text · Article · Dec 2012 · Journal of Breast Cancer
[Show abstract][Hide abstract] ABSTRACT: Our purpose of this study is to develop a computerized classification method for histological classifications of masses using objective features based on clinicians' subjective impressions. An observer study is first conducted to obtain clinicians' subjective impression for nine image features on mass. Nine image features are selected by taking into account image features that clinicians' commonly used for describing masses on ultrasonographic images. In the proposed method, the location and the area of mass are determined by an experienced clinician. We define some extraction methods for each of nine image features. The extraction method is selected such that the correlation coefficient would become the highest between objective features and average of clinicians' subjective ratings. An artificial neural network (ANN) with the nine objective features is employed for distinguishing among four different types of histological classifications on masses. The classification accuracies of the proposed method were evaluated by using 216 ultrasonographic images. The classification accuracies of the proposed method were 85.9% (55/64) for invasive carcinomas, 83.3% (30/36) for noninvasive carcinomas, 89.1% (49/55) for cysts, and 82.0% (50/61) fibroadenomas, respectively.
[Show abstract][Hide abstract] ABSTRACT: We defined the glandular flap including fat in the subclavicular area as an extended glandular flap, which has been used for breast-conserving reconstruction in the upper portion of the breast. Indication. The excision volume was 20% to 40% of the breast volume, and the breast density was dense. Surgical Technique. The upper edge of the breast at the subclavicular area was drawn in the standing position before surgery. After partial mastectomy, an extended glandular flap was made by freeing the breast from both the skin and the pectoralis fascia up to the preoperative marking in the subclavicular area. It is important to keep the perforators of the internal mammary artery and/or the branches of the lateral thoracic artery intact while making the flap. Results. Seventeen patients underwent remodeling using an extended glandular flap. The cosmetic results at 1 year after the operation: excellent in 11, good in 1, fair in 3, and poor in 2. All cases of unacceptable outcome except one were cases with complications, and more than 30% resection of moderate or large size breasts did not obtain an excellent result for long-term followup. Conclusion. This technique is useful for performing the breast-conserving reconstruction of small dense breasts.
[Show abstract][Hide abstract] ABSTRACT: We have used an inframammary adipofascial flap for breast-conserving reconstruction in the inferior portion of the breast since 2005. The aim herein is to report this oncoplastic procedure in detail, including the long-term results. The surgical procedure was as follows: A skin incision is made at the inframammary line. After partial resection of the breast, a tongue-shaped flap of the fat and the anterior sheath of the rectus abdominis muscle are pulled up in the inframammary area. The flap is then inserted into the breast area where the tumor was removed, and it is secured with absorbable sutures to the surrounding breast tissue. When making the flap, it is very important to preserve several intercostal perforators around the inframammary line. Cosmetic results at more than 5 years after the operation in the 5 patients were assessed using photographs. The results were found to be good in 4 cases (80%) and poor in 1 case. The poor outcome was a case with 100% fat necrosis of the flap. This surgical procedure is easy to perform, and the long-term cosmetic outcomes were good, without complications. We consider this procedure to be useful for breast-conserving reconstruction after breast cancer occurring in the inferior portion of the breast.
[Show abstract][Hide abstract] ABSTRACT: A patient presented with a 2 cm lump in the lower outer quadrant of the left breast. Mammogram and ultrasonography showed a solid mass with a microlobulated contour, partially irregular border and microcalcifications. MRI showed an irregular mass with early enhancement and high signal intensity, and the late-phase image demonstrated a partial washout pattern. These findings suggest that the tumour was a malignant invasive carcinoma. Non-invasive ductal carcinoma was diagnosed after a fine needle aspiration and core needle biopsy followed by a partial breast excision and sentinel lymph node (SLN) biopsy. A pathological examination of the lesion displayed characteristic small monomorphic cells, solid proliferation and massive distension within the lobular unit. The tumour was immunohistochemically negative for E-cadherin and pure lobular carcinoma in situ (LCIS) was diagnosed. Pure LCIS is very rare and there have been no previous reports of pure LCIS forming a solid mass.
Preview · Article · Mar 2011 · The British journal of radiology
[Show abstract][Hide abstract] ABSTRACT: PURPOSE/AIM
It is difficult to make correct clinical decisions for biopsy or follow-up on masses in ultrasonographic images. The purpose of this exhibit is to review the usefulness of a computer-aided diagnosis (CAD) scheme for determining histological classifications of breast masses.
We have developed the CAD scheme for determining histological classifications of breast masses by using 8 objective features based on clinicians’ subjective impressions on image features that clinicians commonly use for describing masses on ultrasonographic images. In an observer study for evaluating the usefulness of our CAD scheme, clinicians’ performances were substantially improved by use of the CAD scheme. The average AUC for 7 observers without CAD was 0.714, whereas that with CAD was 0.889.
This exhibit will review the usefulness of the CAD scheme for determining histological classifications of breast masses. The participants will understand: 1) the basic concept of the CAD scheme for determining histological classifications; 2) the advantages and the limitations of the presentation of not only the likelihood of malignancy but also the likelihood of histological classification evaluated by the CAD scheme; 3) the improvement of participant’s own performance by use of the CAD scheme in the observer study.
[Show abstract][Hide abstract] ABSTRACT: Recently, the desmoplastic reaction has been implicated as having an important function in epithelial solid tumor biology. There have been no reports showing the relativity of invasive breast cancer and the desmoplastic reaction by a quantitative analysis of the myofibroblasts that were an important player in the desmoplastic reaction. The purpose of this study was to immunohistochemically investigate the correlation between the desmoplastic reaction and the clinicopathology of invasive breast cancer.
The study included 60 patients with a known prognosis of invasive breast cancer. We quantified the expression of α-SMA as a marker of myofibroblasts in the invasive breast cancer. After staining samples for α-SMA, their expression was extracted and quantified as a relative percentage by computer-assisted image analysis.
There was relatively wide variation in the expression of α-SMA with the percentage of the area from 0.68 to 28.15% (mean 8.48 ± 5.40%). The metastasis group showed significantly higher α-SMA expression compared with the no metastasis group (p < 0.001). When the patients were divided into two groups according to their α-SMA expression using a cutoff point at the mean value of 8.48%, the high α-SMA group had a significantly poorer overall survival rate (p < 0.001). Multivariate analysis demonstrated that α-SMA and lymph node metastasis were identified as independent predictive factors of metastasis.
Myofibroblasts represent an important prognostic factor for invasive growth that is translated into a poor clinical prognosis for patients with invasive breast cancer.
[Show abstract][Hide abstract] ABSTRACT: A 64-year-old postmenopausal female had been treated with insulin therapy for type 2 diabetes mellitus for 18 years, but her diabetes mellitus was not well controlled and she developed retinopathy. Her screening mammography showed abnormal findings, and thus she consulted a hospital. A physical examination showed her mammary glands to be hard on both sides and no palpable mass was observed. Mammography revealed an amorphous calcification in the middle outer portion of the left breast. Ultrasonography showed an irregular hypoechoic mass measuring about 11 mm in size in the upper outer portion of the left breast. Although a core-needle biopsy specimen of the hypoechoic mass showed hyalinizing fibrosis without any evidence of malignancy, a stereotactic guided vacuum-assisted biopsy was performed because magnetic resonance imaging revealed an enhanced area in the region of the amorphous calcification that could not be distinguished from breast cancer. The histological findings indicated noninvasive ductal carcinoma, and therefore a quardrantectomy with a sentinel lymph node biopsy was performed. The pathological diagnosis was invasive ductal carcinoma (0.7 x 0.3 cm) with a predominant intraductal component accompanying diabetic mastopathy. The sentinel lymph nodes demonstrated no metastasis. The surgical margin was positive for carcinoma and the patient later underwent a mastectomy. No malignant cells were observed in the specimen. The patient has so far experienced no recurrence after surgery.