Akemi Tsutsui

Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: An analysis of 16 346 treated nodules in 13 283 patients

Aim:  We surveyed multiple centers to identify types and frequency of complications and mortality rate associated with radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC).

Influence of large intrahepatic blood vessels on the gross and histological characteristics of lesions produced by radiofrequency ablation in a pig liver model

Abstract: Aims: To determine whether the presence of large intrahepatic blood vessels (≥3 mm) affect radiofrequency (RF)‐induced coagulation necrosis, the gross and histological characteristics of RF‐ablated areas proximal to or around vessels were examined in normal pig livers.

Development of an Imaging System Using Fluorescent Labeling Substances Excited by Infrared Rays

Abstract: An indocyanine green (ICG) derivative (ICG N‐hydroxy sulfosuc‐cinimide ester; ICG‐sulfo‐OSu) has been developed as an antibody labeling substance suitable for vital immunohistochemical staining. However, an appropriate fluorescence imaging system for ICG‐sulfo‐OSu using infrared rays has not as yet been reported. Therefore, we developed such a system. The absorption maxima of ICG and ICG‐sulfo‐OSu in buffer solution are both at 795 nm, the excitation maxima of their fluorescence spectra in buffer solution at 768 nm, and their emission maxima at 807 nm. An imaging system using an excitation filter with transmission at 710‐790 nm and a barrier filter with transmission at 810‐920 nm was constructed, and fluorescent images of ICG‐sulfo‐OSu labeled anti‐epithelial membrane antigen (EMA) antibody were obtained with this system. Thus, vital immunohistochemical staining of microcancers under infrared ray excitation should now be possible, by exciting an ICG‐sulfo‐OSu labeled antibody specific to the tumor cells with infrared rays, using this imaging system.

Comparison of Liver Biopsy Findings with the Digestive Disease Week Japan 2004 Scale for Diagnosis of Drug-Induced Liver Injury

The liver biopsy remains a valuable tool in the diagnosis of drug-induced liver injury (DILI). The Digestive Disease Week Japan 2004 (DDW-J) scale proposed as an objective tool for the diagnosis of DILI has been widely used in Japan. So far, the histological features have not been compared with DDW-J scale in detail. Herein, we examined the correlation between liver biopsy findings and clinical features, particularly DDW-J scales. A total of 80 patients with liver injuries of unknown cause were enrolled. Based on the histological findings, these cases were categorized into 3 groups: A (DILI was strongly suspected), B (DILI was suspected), and C (DILI should be considered in the differential diagnosis). Histological groups and DDW-J scale were moderately correlated (κ = 0.60). The mean total DDW-J scale scores were as follows: 4.89 for A, 3.26 for B, and 0.75 for C (p < 0.05). While hepatocellular type was coincided in a majority of cases by histological and DDW-J scale evaluation, cholestatic type was not well coincided. In conclusion, biopsy findings and DDW-J scale were well correlated, and the hepatocellular type of liver injuries was well coincided by both evaluations, though there were several discrepant cases, particularly in cholestatic type.

Therapeutic potential of lenvatinib for unresectable hepatocellular carcinoma in clinical practice: Multicenter analysis: Lenvatinib for HCC patients

Lenvatinib (LEN) has recently become available as a first‐line tyrosine‐kinase inhibitor (TKI) for unresectable hepatocellular carcinoma (u‐HCC). In patients who showed intolerability or failure in other TKI treatments, alternative treatment options are needed. This retrospective study evaluated the therapeutic potential of LEN in clinical practice.

Usefulness and Limitations of Endoscopic Ultrasonography in Diagnosis of Adenomyomatosis of the Gallbladder

Abstract: Although endoscopic ultrasonography (EUS) is commonly used to examine lesions in the gallbladder, its ability to accurately diagnose adenomyomatosis (ADM) has not been evaluated. We compared the accuracy of EUS and various other imaging techniques in the diagnosis of ADM. Thirty‐one patients undergoing cholecystectomy after elevated lesions were found in the gallbladder by various imaging techniques were studied retrospectively. Based on histopathologic examination, the sensitivity and specificity of EUS were evaluated in ADM. The sensitivity of abdominal ultrasonography, CT and ERCP in ADM were also evaluated. Of the 11 patients diagnosed with ADM by EUS, 9 cases were confirmed histologically (81.8%). Of the 11 patients with histologic diagnosis of ADM, 9 were accurately diagnosed preoperatively by EUS (81.8%). EUS proved more reliable for diagnosis of ADM than the other imaging techniques. Important diagnostic features include preservation of the three‐layered structure of the gallbladder, wall‐thickening exceeding 3 mm, and 2 or more Rokitansky‐Aschoff sinuses occurring within a 1 cm area of the gallbladder.

7172 Endoscopic ultrasonography for the diagnosis of gallbladder lesions in patients with gallstones.

Purpose: Gallstones are generally considered a risk factor for gallbladder cancer. Since gallbladder cancer has a poor prognosis, accurate qualitative diagnosis of elevated lesions in the gallbladder is needed, even in the presence of gallstones. In this study, the ability of endoscopic ultrasonography (EUS) to detect gallbladder lesions in patients with gallstones was assessed. Patients and Methods: Between April 1992 and September 1999, 62 patients underwent cholecystectomy for an elevated lesion or thickening of the gallbladder wall identified by imaging techniques including EUS. EUS was performed using the Olympus GF-UM20 (7.5MHz) system. The accuracy of EUS was analyzed in relation to the presence or absence of gallstones, the size and number of stones, and presence or absence of acoustic shadowing.The EUS results were compared with histopathologic results. Significance was tested using the chi-square test and the Students t test. Results: The accuracy of EUS was 70.8% in the gallstone group and 89.5% in the gallstone-free group (NS). The diagnostic accuracy was 75.0% in the patients with stones smaller than 5 mm, 33.3% in the patients with stones between 6 and 10 mm in size, and 77.8% in the patients with stones larger than 11 mm (NS). The accuracy was 66.7% in the patients with 1 to 5 stones, and 83.3% in the patients with 6 or more stones (NS). Acoustic shadowing did not affect the diagnostic accuracy of EUS. Conclusions: Gallstones do not affect the diagnostic accuracy of EUS for gallbladder lesions. However, more diagnostic criteria must be established, and new devices need to be introduced that can provide more information about the lesions.

7234 Usefulness of three-dimensional expression by endoscopic ultrasonography in the diagnosis of gastric cancer invasion.

Objective: Many studies have reported the usefulness of endoscopic ultrasonography (EUS) in the diagnosis of gastric cancer invasion. However, the diagnostic capacity of EUS should be further improved. In this study, we examined the usefulness of three-dimensional expression by EUS in the diagnosis of gastric cancer invasion. Subjects and Methods: In 54 gastric cancer lesions that were histologically diagnosed after April 1995 by EUS using an ultrasonic miniprobe in our department, the rate of accurately diagnosing invasion was compared between period A and period B. The period between April 1995 and October 1996, when examination of threedimensional expression was started at our department, was regarded as period A (35 lesions) , while the period from October 1996 to date was regarded as period B (19 lesions). Furthermore, the usefulness of threedimensional expression was examined in l9 lesions during period B. In the three-dimensional expression, we pulled ultrasonic miniprobe out at definite speed manually, and recorded the images on VTR.We connected VTR output to images processing equipment (IndigO 2 , Silicon Graphics), and compressed each tomographic image (30 frame/sec) by EUS by Motion JPEG method. We selected necessary frames from the images, and converted them into volume data by the three-dimensional image processing software (Medical Design Composer 1.0) which we developed. We determined arbitrary cross sections and the external form on volume data, and observed the lesions spatially. Result: The rate of accurate diagnosis of invasion by EUS was 77.8% (42/54) , overall. Percentages were 74.3% (26/35: T1-m 71.4%, T1-sm 83.3%, T2-pm 50%) during period A and 84.2% (6/19: T1-m 87.5%, T1-sm 66.7%) during period B. During period B, the whole lesion was scanned in each direction for three-dimensional expression. Furthermore, more detailed examination could be performed by expressing random cross sections from three-dimensional data, improving the diagnostic capacity of this procedure. In 8 of 19 patients, superficial expression was possible. In these lesions, the rate of accurately diagnosed invasion was 100% (8/8). Although these patients were selected based on lesion size and the absence of the influence of heart beats, it was suggested that three-dimensional expression contributes to improving the diagnosis of invasion. Conclusion: Three-dimensional expression of EUS findings in patients with gastric cancer may improve the diagnosis of invasion.

7128 Three-dimensional ct pancreatography (3d-ctp) of pancreatic diseases.

Background: Endoscopic retrograde pancreatograpy (ERP) is common techniques used for the diagnosis of pancreatic diseases. However, conventional ERP under fluoroscopy (c-ERP) provides only two-dimensional projection images of the pancreatic ducts. Recent advances in the volumetric CT enable us to get whole pancreatic deta. CT images provide better tissue characterization than fluoloscopy images and ability to create 3D images from its data. Using volumetric CT technique with ERP is thought to be able to provide additional information. Aims: The present study was undertaken to assess the usefulness of 3D-CTP in the diagnosis of pancreatic diseases. Methods: The subjects of this study were 22 patients with pancreatic disease (5 with pancreatic cancer, 5 with chronic pancreatitis and 12 with pancreatic cystic disease). After c-ERP with balloon-catheter, 3D-CTP was performed with volumetric CT within a single brethhold period. Several 3D images per a case were made with the method of shaded surface display(SSD), multiplanar reconstruction (MPR) and maximum intensity projection (MIP) from CT data. Results: Images with SSD and MIP allowed us to realize the pancreatic ducts three dimensionally. The main pancreatic duct (MPD) was visualized three dimensionaly, but the side branches were not enough (see table).Images with MPR provide good visualization of both the pancreatic duct and its parenchyma. In the case of pancreatic cyst, the communication between the cyst and MPD was detected with 3D-CTP. In the case of mutin producing tumor, papillary intraductal tumor was detected more clearly. In the case of pancreatic cancer, dilated pancreatic ducts proximal to the stenosis were observed by 3D-CTP, which could not be visualized by c-ERP, with advantage of contrast resolution of CT. Conclusion: 3D-CTP provides three dimensional images of pancreatic ducts and its parenchyma. It provides additional information about the pancreatic pathologies to c-ERP. 3D-CTP with c-ERP seems to be applicable to simulation for the surgery. The accuracy and clinical usefulness of 3D-CTP will elevated by using improved devices under optimal condition.