Naomi Sakamoto

Monitoring of early response to neoadjuvant chemotherapy in breast cancer with 1H MR spectroscopy: Comparison to sequential 2-[18F]-fluorodeoxyglucose positron emission tomography

To assess the efficacy of 1H MR spectroscopy (MRS) to evaluate early responses to neoadjuvant chemotherapy in breast cancer patients, as compared to that of the standardized uptake value (SUV) in 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET).

Volume replacement with polyglycolic acid mesh for correcting breast deformity after endoscopic conservative surgery.

From April 2002 to August 2003, 60 patients (41 patients undergoing quadrantectomy and 19 patients undergoing wide excision) with early-stage breast cancer underwent endoscopic breast-conserving surgery and volume replacement with absorbable materials. The average volume of resected tissue was 75 mL (range, 15-145 mL). The absorbable materials consisted of polyglycolic acid mesh (Dexon Mesh DMS#4 10 × 12) folded and wrapped in oxidized regenerated cellulose, which just fit into the dead space. We expected that the polyglycolic acid mesh would help induce granulation and fibrous tissue with reactive tissue fluid and that oxidized regenerated cellulose would prevent adhesion between the skin and the polyglycolic acid mesh (Figure 1). The absorbable materials were gently inserted into the dead space, and the wound was closed in 3 layers. We used 1 sheet of polyglycolic acid mesh and 1 sheet of oxidized regenerated cellulose if the volume loss was 70 mL. The cosmetic outcome was evaluated with a 4-point scoring system of breast cosmesis judged by breast surgeons.1 The scores of breast cosmesis were evaluated every 1 or 2 months at a clinic. The average evaluation time was 6.1 months after surgery (range, 2-12 months). A favorable cosmetic outcome (excellent) was obtained in 83% of patients (77% of patients undergoing quadrantectomy and 91% of patients undergoing wide excision). Dynamic contrast-enhanced magnetic resonance mammography and ultrasonography were performed routinely 3 months after the operation. The images showed that the dead space was lined by granulated scar tissue and filled with fluid. Deformity was almost completely prevented, and the symmetric images helped us to detect local recurrence. In 1 patient, multiple cancers were detected by pathologic examination after conservative breast surgery. Total mastectomy was performed 1 month after the previous operation, and the resected tissue in which polyglycolic acid mesh had been inserted was examined pathologically. Pathologic examination showed that the peripheral part of the dead space was encapsulated by granulation and fibrous tissue, and the mesh was decomposed and phagocytosed by macrophages. Complications of the film-screen mammography (FSM) method were inflammation and overproduction of fluid induced by the polyglycolic acid mesh. These findings were observed in 3 cases that had been diagnosed by open biopsy before surgery. We believe that the open biopsy procedure induced inflammation and overproduction of fluid in these patients. We now regard a history of open biopsy to be a contraindication for the FSM method. It is likely that polyglycolic acid mesh helps to promote granulation and to fill the reactive fluid space in the encapsulating scar. The FSM method is a simple and useful procedure for preventing breast deformity after conservative surgery.

Magnetic resonance-guided vacuum-assisted breast biopsy: results in 100 Japanese women.

PurposeThe aim of this study was to clarify the frequency of malignancy and the histopathological characteristics of the lesions in patients undergoing magnetic resonance imaging (MRI)-guided vacuum-assisted biopsy (VAB).Materials and methodsA retrospective review of 100 consecutive patients with 102 lesions who had undergone MRI-guided VAB was performed. The biopsies were performed on a 1.5-T MR scanner using a commercially available biopsy system. None of the lesions seen with MRI could be detected by mammography or second-look ultrasonography.ResultsThe average lesion sizes of the focus, mass, and nonmass lesions before the biopsy were 4.5, 8.2, and 21 mm, respectively. Twelve patients (12%) had lesions located in the deep portion of the breast, close to the pectoral muscle. The biopsy was successfully performed without important side effects in all patients. Histopathological findings were invasive ductal carcinoma in 6 (6%), in situ carcinoma in 28 (27%), and high-risk and benign in 68 (67%). Two high-risk lesions were upgraded to ductal carcinoma in situ (DCIS), and three DCIS lesions were upgraded to invasive ductal carcinoma at surgical excision.ConclusionThe high rate of DCIS might be a unique feature among Japanese women. However, MRI-guided VAB is necessary for MRI-only visible suspicious lesions in Japan.

Early results of an endoscopic nipple-sparing mastectomy for breast cancer.

Background.Endoscopic mastectomy has been reportedly associated with smaller scars and greater patient satisfaction; however, few reports on this topic have been made. The purpose of this retrospective study was to examine the early results of endoscopic nipple-sparing mastectomy (ENSM) and to investigate the safety of this procedure.Methods.Between January 2002 and December 2005, a total of 87 patients with breast cancer but without skin and nipple involvement, including two cases of bilateral breast cancer, underwent E-NSM. In case of bloody nipple discharge and suspicious extension near the nipple as assessed by magnetic resonance imaging, the major ducts within the nipple were cored (nipple coring). In other cases, nipple coring was not performed.Results.Of the 89 breasts in 87 patients, 42 had tumors of >2 cm and 80 were diagnosed as having invasive carcinoma. Lymph node involvement was observed in 36 procedures. The overall rate of nipple necrosis was 18% (16 of 89). The rate of nipple necrosis among the procedures with nipple coring was statistically higher than that among those without nipple coring (7 of 17, 41%, vs. 9 of 72, 13%) (P = .01). Nipple involvement was observed in 2.2% (2 of 89). After a median follow-up period of 52 months, distant metastasis was observed in nine cases; no local recurrences occurred in this series.Conclusions.E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy. The higher rate of nipple necrosis may have been the result of a technical problem, indicating the need for continued improvement in nipple coring procedures.

New preoperative MRI marking technique for a patient with ductal carcinoma in situ

We herein present a case of non-palpable ductal carcinoma in situ (DCIS) treated with successful breast-conserving surgery (BCS) using MR markers made with commercially available materials in the supine position. The patient was a 40-year-old woman found to have a non-mass lesion by routine screening ultrasonography (US). The margin of the lesion was unclear by the US examination, whereas contrast-enhanced MR mammography (MRM) revealed a clear margin of the lesion. After the resection line was determined by under US guidance, the area was marked by original markers for MRI using the pills of Breath Care® inside a Penrose drain. MRM was performed in the supine position (supine MRM), which is similar to the posture used for surgery. The lesion was located within the resection area, but it was not at the center of the resection area; thus, the resection lines were modified using information obtained by MRM. The histological evaluation of the BCS specimen demonstrated a wide extension of the DCIS. The lesion was located at the center of the resection specimen, and the surgical margin was free. In conclusion, since our procedure can be performed easily, it is useful for evaluating the extent of the lesion as determined by the US examination in difficult cases.