Aya Nakagawa

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.

Risk of Second Primary Malignancy After Esophagectomy for Squamous Cell Carcinoma of the Thoracic Esophagus

PURPOSE To assess the risk of subsequent malignancies after esophagectomy for squamous cell carcinoma of the thoracic esophagus for the establishment of an adequate follow-up program. PATIENTS AND METHODS We statistically analyzed clinical factors in 114 cases of second malignancy after esophagectomy that developed in 94 of 679 patients who underwent curative resection. The cancer incidence rates in the general population estimated by the Research Group for Population-Based Cancer Registration in Japan were used as standards for comparison. RESULTS The 10-year cumulative risk of second malignancy was 34.5%, and the overall relative risk (RR) was 2.98 (95% CI, 2.41 to 3.65). The risk of head and neck cancer was markedly elevated (RR, 34.9; 95% CI, 24.3 to 48.6), followed by the risks of lung cancer (RR, 3.24; 95% CI, 1.89 to 5.19) and stomach cancer (RR, 2.00; 95% CI, 1.17 to 3.21). Multifactor analysis demonstrated that independent factors affecting the risk of subsequent malignancies were presence of other malignancies detected before esophagectomy and any of the following factors: masculine sex, alcohol consumption, and smoking. The 5-year survival rate after detection of subsequent malignancy was 45%. The outcome in patients with subsequent head and neck cancer was significantly less favorable as a result of difficulty in early detection. CONCLUSION Patients had a remarkably high risk of subsequent cancer of the upper aerodigestive tract after esophagectomy, in particular, head and neck cancer. Minute postoperative surveillance is strongly recommended, especially in patients with a history of malignancies before esophagectomy. Early detection of second malignancies allowed less invasive treatment with favorable outcome.

New Antineoplastic Agent, MK615, from UME (a Variety of) Japanese Apricot Inhibits Growth of Breast Cancer Cells in vitro

Abstract:  MK615 is an extract mixture containing hydrophobic substances from Japanese apricot. In this study, the antineoplastic effects of MK615 against breast cancer cells were investigated. Two breast cancer cell lines, MDA‐MB‐468 (MDA) and MCF7, were cultured with (600, 300, and 150 μg/mL) or without MK615. After 72 hours of incubation, growth inhibition was evaluated by MTT assay. The cells were then cultured with MK615 (300 μg/mL) and morphological changes were studied by light and electron microscopy. Finally, the mechanism of the antineoplastic effect of MK615 was evaluated by cell cycle and apoptosis assay. MK615 inhibited the growth of MDA and MCF7 in a dose‐dependent manner. The percentage growth inhibition of MDA at dosages of 600, 300, and 150 μg/mL was 59.2%, 52.4%, and 23.3%, respectively, and that for MCF7 was 83.5%, 52.7%, and 16.6%, respectively. Morphological changes after MK615 treatment included massive vacuolization in the cytoplasm and apoptotic changes in the nucleus. These changes began to be apparent after at least 6 hours of incubation. Cell cycle analysis showed that MK615 increased the proportion of cells in the G2‐M phase in both MDA (7.8–11.7%) and MCF7 (8.1–18.7%), and finally both cell lines became apoptotic. The proportion of apoptotic cells increased with incubation time. MK615 effectively inhibits the growth of breast cancer cells in vitro, possibly by cell cycle modification and apotosis induction. MK615 should be further investigated as a promising anti–breast cancer agent.

Laparoscopic resection of epidermoid cyst arising from an intrapancreatic accessory spleen: a case report with a review of the literature.

We describe a rare case of epidermoid cyst arising in an intrapancreatic accessory spleen that presented as a cystic mass in the tail of the pancreas, and for which laparoscopic distal pancreatectomy was performed successfully. A 36-year-old woman with a cystic mass in the tail of the pancreas, which had been discovered incidentally at a medical checkup, was referred to our department for further examination. Endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography and positron emission tomography demonstrated a multilocular cyst in the tail of the pancreas without any evidence of malignancy, although differential diagnosis was extremely difficult because of the neoplasm-like appearance of the lesion. Therefore, we performed laparoscopic distal pancreatectomy under a preoperative diagnosis of mucinous cystic neoplasm. Postoperative pathologic examination demonstrated an epidermoid cyst arising from a heterotopic spleen within the pancreas. This is the first report of successful laparoscopic distal pancreatectomy for an epidermoid cyst arising in an intrapancreatic accessory spleen. One virtually has no chance to diagnose an epidermoid cyst in an accessory spleen on the basis of preoperative diagnostic workup, and consequently the type of surgical resection (open vs. laparoscopic) would be conditioned by factors other than the clinical entity suspected at the preoperative period.

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.