Koichi Shibutani

Temporal variations in stump pressure and assessment of images obtained from cone‐beam computed tomography during balloon‐occluded transarterial chemoembolization

Balloon‐occluded transcatheter arterial chemoembolization (B‐TACE) was used to show the optimized duration of balloon occlusion to start injection of lipiodol in order to maximize lipiodol deposition in the nodule, and to reveal the endpoint of lipiodol injection.

Combination therapy consisting of arterial infusion chemotherapy (EPF, EAP) and transcatheter arterial embolization (TAE)

From January 1988 to January 1993, 45 patients with unresectable advanced hepatocellular carcinoma (HCC) were treated with a new combination therapy consisting of arterial infusion chemotherapy and TAE. The combination therapy was performed according to our treatment schedule as follows: two courses of arterial infusion chemotherapy were given first, and then transcatheter arterial embolization (TAE) using a mixture of Lipiodol and cisplatin powder was performed. Two arterial infusion chemotherapeutic regimens were employed: EPF (etoposide, cisplatin, and 5-fluorouracil) and EAP (etoposide, Adriamycin or Epi-adriamycin, and cisplatin). The anticancer drugs were infused through a catheter inserted into the proper or common hepatic artery. Assessment was made of the anticancer effect and survival rate of each treatment method. The response to each therapy was evaluated on the basis of CT performed prior to and after the treatment. In the EPF·TAE group, the response rate was about 46%, whereas in the EAP·TAE group it was 48%. Overall, 21 of 45 patients attained a regression rate of 50% or more. Furthermore, daughter nodules decreased in size or disappeared in about 67% of 15 patients. Additionally, tumor thrombi tended to show a similar response. In all of the cases, the average duration of survival was 30.3 months, and the 1-year survival value was 68%, the 2-year survival value was 44%, and the 3-year survival value was 35%. These results were superior to those obtained with TAE therapy alone.

Contribution of dynamic sentinel lymphoscintigraphy images to the diagnosis of patients with malignant skin neoplasms in the upper and lower extremities

The aim of the present study was to confirm the contribution of dynamic images in sentinel lymphoscintigraphy in malignant skin neoplasms: precisely, to investigate if dynamic images were necessary and to observe if dynamic images could reduce the areas needed for biopsy and dissection. Twenty-five patients with malignant skin neoplasms of the lower (n = 21) and upper (n = 4) extremities were retrospectively investigated. Images were evaluated by two independent reviewers, an expert in diagnostic radiology and nuclear medicine and a diagnostic radiologist in training. Visualized hot spots were assessed to be sentinel nodes using only static planar images. Next, both static planar and dynamic images were assessed. Reviewers scored diagnostic confidence values of determined sentinel nodes as follows: 0, cannot be decided; 1, possible; 2, probable; and 3, definitive. Patterns of lymphatic drainage were categorized into six different pathways: (1) inguinal type, (2) popliteal type, (3) inguinal and popliteal type, (4) axillary type, (5) cubital type, and (6) axillary and cubital type. In cases in the lower extremities, with dynamic images, the expert reviewer changed assessment in three cases and the trainee reviewer changed it in one case. There were no cases in which a decision was changed to be the same between both reviewers. Although the average diagnostic confidence value of assessment is usually higher with dynamic images, significant differences were not present. In cases of the upper extremities, both reviewers changed their assessment in one patient. By mutual agreement, cases in which assessment was changed with dynamic images were the inguinal and popliteal type, and the axillary and cubital type. The expert reviewer noticed lymphatic channels only visualized on dynamic images and changed assessment. Determination of whether or not a lymph node is a sentinel node depends on visualization of the lymphatic network. In the present circumstances, all biopsies of hot spots determined to be lymph nodes should not be excluded. However, excessive biopsies should be avoided as much as possible. It is necessary to use dynamic images alongside skillful observation.

Development of Hepatocellular Carcinoma in Chronic Hepatitis C Patients 20 Years after Achieving a Sustained Virological Response with Interferon Therapy: A Report of Two Cases

Advances in interferon (IFN)‐based therapy for chronic hepatitis C have led to a high rate of sustained virological response (SVR), which means viral clearance. However, some cases have been reported to develop hepatocellular carcinoma (HCC) over 10 years after achieving the SVR. Here, we report two patients who developed HCC 20 years after SVR with IFN therapy. Both of the patients were male and achieved SVR at the age of 46 years and 61 years, respectively. These cases suggest the need for long‐term follow‐up in patients with chronic hepatitis C even if SVR is achieved.