Akihito Abe

Intraoperative identification of sentinel lymph nodes by near-infrared fluorescence imaging in patients with breast cancer

We present a novel method for sentinel lymph node (SLN) identification by fluorescence imaging that provides a high detection rate and a low false-negativity rate. Twenty-five breast cancer patients with tumors less than 3 cm in diameter were enrolled. A combination of indocyanine green and indigo carmine was injected subdermally in the areola. Subcutaneous lymphatic channels draining from the areola to the axilla were immediately showed by fluorescence imaging. After incising the axillary skin near the point of disappearance of the fluorescence, the SLN was dissected under fluorescence guidance. In all patients, the lymphatic channels and SLN were successfully visualized. The mean number of fluorescent SLN and blue-dyed SLN were 5.5 and 2.3. Eight patients were found to have lymph node metastases pathologically. All of them were recognized by fluorescence imaging. This method is feasible and safe for intraoperative detection of SLN allowing real-time observation without any need for training.

Depth of tumor invasion in locally advanced rectal cancer correlates with patients’ prognosis: The usefulness of elastic stain for its measurement

PurposeThe relationship between the prognosis and the extent of colorectal carcinoma (CRC) is still unclear. As a simple parameter of the local invasion of CRC, we assessed the extent of tumor invasion beyond the outer border of the muscularis propria (MP).MethodsWe examined 147 cases of CRC using a slight modification of the procedure established by the Japanese Society for Cancer of the Colon and Rectum. For the statistical analysis, the patients were divided into two groups, namely, a “shallow” group and a “deep” group, using a specific cut-off value (COV). A multivariate analysis to identify independent prognostic factors was performed.ResultsSignificant differences in the 5-year survival rate were observed between the “shallow” and “deep” groups in 39 cases of rectal carcinoma (COV 4 mm; 72.4% vs. 30.0%, hazard ratio = 3.204), but not observed in 147 cases of CRC. In addition, the outcome for patients with “deep” cancer in the lower rectum was markedly worse than that for patients with “shallow” cancer (COV 4 mm; 81.8% vs. 12.5%, hazard ratio = 5.371).ConclusionsThe depth of tumor invasion beyond the MP is thus considered to be an important prognostic factor for patients with T3/T4 rectal carcinoma, especially in the lower rectum. A careful follow-up is required for the patients with rectal carcinoma that has invaded more than 4 mm beyond the MP.

Role of Necl-5 in the pathophysiology of colorectal lesions induced by dimethylhydrazine and/or dextran sodium sulphate.

Necl‐5 is an immunoglobulin‐like molecule that was originally identified as a poliovirus receptor. Although Necl‐5 expression is often up‐regulated in cancer cells, its pathophysiological significance in the development of cancer remains unclear. We investigated the roles of Necl‐5 in the development of colitis‐associated neoplasia. Necl‐5‐deficient mice were generated and treated with dimethylhydrazine (DMH) and/or dextran sodium sulphate (DSS) to induce colitis and its associated neoplasias. Colon tissues were examined for histology, Ki‐67 expression by immunohistochemistry and K‐ras gene mutation. Colon tumours occurred significantly less frequently in heterozygous (Necl‐5+/−) or homozygous Necl‐5‐deficient (Necl‐5−/−) mice than in wild‐type (WT) mice with DMH/DSS treatment. Total ulcer index and inflammatory cell infiltration were significantly lower in Necl‐5−/− mice than in WT mice with DSS alone or DMH/DSS treatment. Colon tumours in both WT and Necl‐5−/− mice showed high cell proliferation ability but lacked K‐ras mutation. The total Ki‐67 labelling index in non‐neoplastic colon epithelium was significantly higher in WT (45.9 ± 0.94) than in Necl‐5+/− (34.3 ± 1.40) or Necl‐5−/− (27.7 ± 1.15) mice with DMH/DSS treatment (p < 0.001). Necl‐5 plays a role in the development of colitis‐associated cancer by up‐regulating colonic mucosal cell proliferation. Copyright

Involvement of cyclooxygenase-2 and vascular endothelial growth factor in vascularization and lymph node metastasis of colorectal cancers with submucosal invasion

Background and Aims:  Although patients with early colorectal cancer invading the submucosa (CRC‐sm) may be treated with endoscopic mucosal resection alone, they generally undergo additional surgery because of the risk of lymph node metastasis. The aims of the present study were to examine the roles of cyclooxygenase‐2 (COX‐2) and vascular endothelial growth factor (VEGF) in tumor vascularization and to investigate whether COX‐2 and VEGF expression and tumor vascularity are useful markers for predicting lymph node metastasis in CRC‐sm.

Non-Invasive Identification of Sentinel Lymph Nodes Using Indocyanine Green Fluorescence Imaging in Patients with Breast Cancer~!2009-11-04~!2009-12-23~!2010-05-26~!

Background: Recently, sentinel lymph node biopsy (SLNB) has been carried out routinely in patients with early breast cancer. Avoidance of axillary lymph node dissection is considerably desirable items of maximizing the quality of life of postoperative patients Here we report non-invasive identification of SLN using indocyanine green (ICG) fluorescence imaging, which provides a high detection rate and a low false-negativity rate. Patients and Methods: One hundred and fifty breast cancer patients with tumors less than 3 cm in diameter were enrolled in this study. ICG dye and indigo carmine were injected subdermally at the same time into the areola. Subcutaneous lymphatic channels draining from the areola to the axilla were immediately rendered visible by fluorescence imagings using a Photodynamic Eye (PDE). After incising the axillary skin over the location of the LN identified by ultrasonography, the SLN was dissected under fluorescence imaging guidance with adequate adjustment of sensitivity. Results: Lymphatic channels and SLN were successfully identified in all patients. The mean number of SLN and the operation time for SLNB were 3.2 and 15.2 min, respectively. Twenty-six patients (17.3%) were found to have lymph node metastases pathologically. Adjustment of the sensitivity of PDE facilitated a reduction in the operation time. There were no intra- or postoperative complications associated with SLN identification. Conclusions: This method is feasible, safe, and only minimally invasive for intraoperative detection of SLN, allowing real-time observation without any need for training.

Preoperative globulin-to-albumin ratio predicts outcome after curative resection in patients with gastric cancer

The globulin‐to‐albumin ratio (GAR) is useful for prognostication of patients with various cancers. However, the significance of GAR in gastric cancer (GC) remains unclear. Our purpose was to investigate the relationship between the GAR and outcome after curative resection in GC patients.