Juji Tsuchiya

Preoperative Diagnosis of Breast Diseases by Dynamic MR Mammography: Cut-off Point Establishment for Signal Intensity Ratio

We have demonstrated that the dynamic study for breast lesions by magnetic resonance Imaging (MRI) can differentiate benign from malignant lesions objectively. The cases were57 histopathologically appraised breast lesions, including 20 cases of breast cancer, 28 cases of mastopathy, 8 cases of fibroadenoma and 1 case of intraductal papillomatosis. We plotted time-signal intensity ratio curves and then determined 95% confidence intervals, plotting the signal intensity ratio for both breast cancer and mastopathy every 30 seconds during dynamic magnetic resonance mammography (MRM) after gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) administration, and further established cut-off points to differentiate between them. We then tried of estimate objectively the benign-malignant differentiation to breast lesions by confirming their signal intensity ratio to be more or less than the cut-off points. We advocate this procedure, and call it the “dynamic ratio method.”As a result, we found highly significant differences between breast cancer and mastopathy at 30 and 60 seconds after Gd-DTPA administration (P<0.0001 ). We also confirmed that the cutoff point for the dynamic ratio method was equivalent to 1.4 and 1.8 times the precontrast signal intensity value at 30 and 60 seconds after administration of Gd-DTPA respectively. By performing this dynamic ratio method preoperatively we can assess objectively not only the malignancy of breast lesions, but also neighboring infiltration, extending intraductal component, and lymph node metastasis. Furthermore, the dynamic ratio method provides detailed information for selecting the appropriate region for breast conserving surgery preoperatively, and can be expected to reduce unnecessary biopsies of benign cases. The dynamic ratio method had a sensitivity of 95.0%, a specificity of 81.1% and a positive predictive value of 73.1%. Also, for detecting invasive ductal carcinoma, the sensitivity of the dynamic ratio method was 100.0%.

Preoperative diagnosis of an asymptomatic cancer restricted to the cystic duct

INTRODUCTION Even now, cystic duct cancer (CDC) as defined by Farrar is rare and has a better prognosis than gallbladder cancer, although CDC as defined by Ozden et al., the definition of which could apply to early and advanced cases of CDC, is not rare and has a poorer prognosis than the CDC defined by Farrar. PRESENTATION OF CASE A 78-year-old woman with no complaints was found to have a tumor restricted to the cystic duct. Three cytology examinations of the patients bile could not establish that the tumor was an adenocarcinoma. However, adenocarcinoma was suspected due to the hypervascularity shown on contrast-enhanced computed tomography. Cholecystectomy and extrahepatic bile duct resection with D2 lymph node dissection was performed. The pathological study revealed it to be CDC. Her postoperative course has been uneventful and without recurrence for 21 months. DISCUSSION At their first medical examination, many CDC patients are found to have such advanced spread of the cancer to adjacent organs that an extended operation might be necessary. As in our case, better patient outcome results when no lymph node or remote metastasis is present. CONCLUSION Diagnosing CDC as early as possible contributes to curative resections and favorable patient outcomes and also allows surgeons to recommend a mini-invasive procedure to their patients rather than extended resection including that of adjacent organs.

Hand-Scanning Ultrasound Mass Screening for Breast Cancer in Women Aged Under 50

15年間における手動超音波併用乳癌検診 (以下, US併用検診) で検出した乳癌症例82例について受診時年齢を50歳未満と50歳以上に分けて集検精度, 診断能, 有自覚症状率を比較した. 結果, 50歳未満では50歳以上に比して要精検率, 有自覚症状率が有意に高く陽性予知度が有意に低いものの, 乳癌発見率, 感度, 特異度はほぼ同率であり50歳以上と同様に有用なUS併用検診が可能である事が判明した.組織型の検討では50歳未満の非浸潤癌症例比率が50歳以上に比して有意に多いことが判明した. US併用検診では若年受診群において浸潤癌化する以前に乳癌を早期発見することができることを示唆している.15年間を5年毎の3期に分け腫瘤径を検討したところ, このUS併用検診の経年的腫瘤径縮小効果が示唆された. 即ち, 微小腫瘤径乳癌が多くなった結果, 非触知乳癌症例が集検例の26.6%を占めるうえにその72.3%が浸潤癌症例であったことが判明した. これを更に年齢別に見ると, 50歳未満の群ではその乳腺の硬さから50歳以上の群に比して非触知乳癌症例比率が多くなって30.2%を占め, その69.2%が浸潤癌症例であった. 視触診検診のみの検診ではこれらは見落とし例となり, 増加しつつある50歳代の乳癌死 亡率を更に増悪させることになるので, これを抑制するために50歳未満の若年受診群に対して安全で有効なUS併用検診を早急に導入することを提言する.