Isamu Morishima

Effect of adding screening ultrasonography to screening mammography on patient recall and cancer detection rates: A retrospective study in Japan

PURPOSE To determine whether adding screening ultrasonography to screening mammography can reduce patient recall rates and increase cancer detection rates. MATERIALS AND METHODS We analyzed the results of mammography and ultrasonography breast screenings performed at the Total Health Evaluation Center Tsukuba, Japan, between April 2011 and March 2012. We also reviewed the modalities and results of diagnostic examinations from women with mammographic abnormalities who visited the Tsukuba Medical Center Hospital for further testing. RESULTS Of 11,753 women screened, cancer was diagnosed in 10 (0.22%) of the 4529 participants who underwent mammography alone, 23 (0.37%) of the 6250 participants who underwent ultrasonography alone, and 5 (0.51%) of the 974 participants who underwent mammography and ultrasonography. The recall rate due to mammographic abnormalities was 4.9% for women screened only with mammography and 2.6% for those screened with both modalities. The cancer detection rate was 0.22% for women screened only with mammography (positive predictive value, 4.5%) and 0.31% for those screened with both modalities (positive predictive value, 12.0%). Of the 211 lesions presenting as mammographic abnormalities investigated further, diagnostic ultrasonography found no abnormalities in 63 (29.9%) and benign findings in 69 (33.7%). The rest 36.4% needed mammography, cytological or histological examinations or follow-up in addition to diagnostic ultrasonography. CONCLUSIONS It is possible to reduce the recall rate in screening mammography by combining mammography and ultrasonography for breast screening.

Incident Angle of the Plunging Artery of Breast Tumors

We measured the incident angle of the feeding artery of breast tumors on color Doppler ultrasonography. Ninety-two tumors that had plunging arteries (21 fibroadenomas and 71 breast cancers) were retrospectively evaluated. Breast cancers were divided into three types [accentuating type (ACC), 25; intermediate type (INT), 35; and attenuating type (ATT), 11] by posterior echo. Color Doppler ultrasonography was performed using an HDI 5000 (ATL Ultrasound, USA) with a 7- to 10-MHz linear probe.We measured the incident angle of the feeding artery on color Doppler imaging. If the tumor had many plunging vessels, we measured all of them. The average incident angle of the artery of fibroadenoma was 47.5° and that of breast cancer was 17.6°. Fibroadenoma ranged from 15° to 70° and breast cancer from 0° to 70°. In breast cancer, there were no significant differences among the three types (ACC, INT, and ATT). We concluded that the incident angle of the feeding artery adds valuable information to the color Doppler ultrasonographic diagnosis for breast tumors.

Ultrasonic Diagnosis of Non-Mass Image-Forming Breast Cancer

We investigated the characteristics of non-mass image-forming breast cancer and the relationship between non-mass image-forming breast cancer and ductal carcinoma in situ (DCIS). We reviewed 47 non-mass image-forming breast cancers and 75 ultrasonic images of DCIS. We classified non-mass image-forming breast cancers into four subtypes: a homogeneous pattern, a ductal pattern, a mottled pattern, and a geographic pattern. The 47 cases were classified into 2, 6, 12, and 27 cases, respectively. Histological findings were 24 DCIS, 19 invasive ductal carcinomas with predominant intraductal components, and 4 invasive carcinomas. The 16 of 27 cases with a geographic pattern included invasive components. The 15 of 24 geographic cases had a comedo type of intraductal component. Of the 75 cases of DCIS, 51 cases were a mass image-forming type and 24 cases were a non-mass imageforming type. The histological findings for non-mass image-forming breast cancer tend to be DCIS and/or invasive ductal carcinoma with a predominant intraductal component. The geographic pattern often contained invasive components. The geographic pattern and/or the lesion with echogenic spots often had a comedo type. These results revealed the close relationship between the progress of breast cancer and ultrasonic imaging.

Dialister pneumosintes bacteremia caused by dental caries and sinusitis.

A 62-year-old Japanese woman was hospitalized at the Department of Senology for positive signals on two sets of blood cultures obtained in the Emergency Department. The initial physical examination with enhanced computed tomography of the chest and abdomen did not identify the infectious source. Dialister pneumosintes was identified on 16S rRNA sequencing, and dental caries with sinusitis were subsequently diagnosed based on a dental examination and magnetic resonance imaging. History taking with respect to dental hygiene and oral examinations should be performed in daily clinical practice, especially in immunosuppressed patients.

Draft Diagnostic Guidelines for Non-Mass Image-Forming Lesions by the Japan Association of Breast and Thyroid Sonology (JABTS) and the Japan Society of Ultrasonics in Medicine

We have reported the Diagnostic Guidelines for Non-Mass Image-Forming Lesions. These have been discussed in the subcommittee of the Japan Association of Breast and Thyroid Sonology (JABTS) and the Japan Society of Ultrasonics in Medicine.

Margin, Border, and Boundary Zone of Breast Tumor Ultrasonography

To make a standard diagnosis, it is important to have a standard lexicon. Although many kinds of expression are possible for the same feature of a breast tumor, a technical term must be a word that is seldom confused with another different concept. Especially, a halo or boundary high echo must be a word that is used to express a malignant sign.

Revised Diagnostic Criteria for the Breast (Draft): Internal Echoes

Many aspects of internal echoes of mass image-forming breast lesions have been discussed. These points, as well as other themes, should be documented or corrected through further investigation in wide clinical practice.

Draft JSUM Diagnostic Guidelines for Mass Image-Forming Lesions

76 Diagnostic Criteria for Breast Lesions has been widely used since its release in 1988 by the Japan Society of Ultrasonics in Medicine (JSUM). However, improved diagnostic procedures and new data led to a growing desire for revisions to this publication. Prompted by that growing demand, in 2000 the JSUM set up a Subcommittee on Diagnostic Criteria for Breast Diseases (SCDCBD-JSUM; chairman, Ei Ueno), thus launching a study of new diagnostic guidelines for these diseases. The subcommittee classified breast diseases into two categories, mass imageforming and non-mass image-forming lesions as shown on ultrasonograms, and won approval of its classification for mass image-forming lesions as part of the revision process. These revisions were published in the Journal of Medical Ultrasonics and JSUM members have been invited to comment. The Japan Association of Breast and Thyroid Sonology’s Committee on Diagnostic Criteria for Breast Diseases (CDCBDJABTS; chairman, Tokiko Endo) also engaged in a study of the terminology that provides the basis for these classifications. Details of these studies are elaborated here.